Fatal and nonfatal pediatric opioid poisonings have increased in recent years. Emergency medical services (EMS) clinicians are often the first to respond an poisoning administer reversal therapy. Currently, epidemiology of prehospital naloxone use among children adolescents is incompletely characterized. Thus, our study objective was describe administrations reported by EMS during activations United States.

Introduction: Procedural sedation (PS) is commonly performed in the emergency department (ED). Nil per os (nothing by mouth) (NPO) guidelines extrapolated from standards for patients undergoing elective procedures operating room have been applied to ED PS patients. There has no large study of comparing differences adverse events and success rates based on NPO status. Methods: From a cohort consecutive all ages 20 EDs one hospital system—one quaternary ED, four tertiary EDs, six community...

Emergency medical services (EMS) post-overdose outreach programs expand beyond traditional 9-1-1 response to offer overdose survivors linkage substance use treatment and other related harm-reducing interventions. Although intuitive increasingly popular, evidence define expected outcomes is exceedingly limited. We evaluated process patient of one large Midwestern program describe characteristics treatment. This retrospective cohort study used clinical records individuals referred a...

Emergency medical services (EMS) frequently respond to patients with opioid-related overdoses but often lack the infrastructure and capacity provide resources support individuals who decline transportation emergency department. Post-overdose response teams pair EMS clinicians other first responders or substance use treatment professionals outreach, harm reduction materials, recovery resources. We aimed explore experiences of post-overdose team members better inform a prehospital care...

Opioid overdose is a leading cause of death in the United States, and engaging with patients following to provide harm reduction recovery resources can prove difficult. Quick response models use mobile, multidisciplinary teams establish time-sensitive connection between individuals who overdosed that improve outcomes. These quick are consistent broader field mobile-integrated health programs growing number acceptability, though literature base sparse vary. We describe 5-year reach,...

Background ST-segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning ischemia. Process measures target median door-to-ECG (D2E) time of 10 minutes. Methods and Results This 3-year descriptive retrospective cohort study, including 676 ED-diagnosed STEMI from geographically diverse facilities across the United States, examines alternative approach to quantifying performance:...

Objective Mobile integrated health care (MIH) leverages emergency medical services (EMS) clinicians to perform local functions. Little is known about the individual EMS working in this role. We sought describe prevalence, demographics, and training of providing MIH United States (US).Methods This a cross-sectional study US-based, nationally certified civilian who completed National Registry Emergency Medical Technicians (NREMT) recertification application during 2021–2022 cycle voluntary...

Context: New approaches to emergency response are a national focus due evolving needs and growing demands on the system, but perspectives of first responders potential partners have not been evaluated. Objective: This project aimed inform development implementation alternative models, including interdisciplinary partnerships, by identifying frontline workforce regarding their roles. Design: An electronic survey was sent, querying respondents about perceived roles in response, resources...

Importance Layperson-administered naloxone (LAN) is a powerful but incompletely characterized intervention to prevent opioid-related overdose mortality. LAN trends are relevant policy and strategic planning in distribution initiatives. Objective To assess the 2-year trend for persons United States receiving during emergency medical services (EMS) activations. Design, Setting, Participants This retrospective cross-sectional study was conducted from June 2020 2022 among 65 621 195 EMS...

In this research, we examine the interplay between ‘actors’ and ‘agents’ in Distributed Ledger Technology (DLT) systems. We identify regulatory interactions off-chain agents setting rules, as well on-chain code actors regulating behavior of DLT users. theorize about relationship that mutually regulate each other certain ways through system significant dimensions related to trifecta which soft agent sphere regulation is likely interact with hard actor by DLT. By proposing design, protocol,...

Importance Identifying longitudinal changes in advanced airway management by emergency medical services (EMS) is crucial for understanding practice patterns and optimizing care. Objective To examine the trends endotracheal intubation (ETI) supraglottic (SGA) utilization a national EMS cohort. Design, Setting, Participants This retrospective cross-sectional study analyzed 2011 to 2022 data from ESO Data Collaborative, database of US prehospital electronic health records. The included all 911...

Abstract Objectives In August 2021, “Operation Allies Welcome” evacuated 76,000 Afghan refugees to 8 US temporary housing facilities. The impact of refugee influx on local emergency department (ED) use and the resources needed during resettlement are poorly described. We report frequency pediatric ED visits characterize by from 1 facility. Methods This single‐center, retrospective cohort study identified participants via a identifier in medical record. primary outcome was timing visits;...

Our primary goal was to evaluate safety of a new emergency medical services (EMS) protocol directing non-transport low-acuity patients during the COVID-19 pandemic.We performed retrospective cohort analysis all in Marion County, Indiana, from March 23, 2020 May 25, for whom novel used by EMS with symptoms. We assessed paramedic compliance determine numbers and types deviations. further reviewed statewide health information exchange database identify any department (ED) visits, hospital...

Abstract Background Home‐based primary care promotes aging in place but is not immediately responsive to urgent needs. Community paramedicine leverages emergency medical services clinicians expedite in‐home care, though limited evidence supports this model. We evaluated the and acute use of older adults urgently by a community paramedic with telemedicine physician compared home visit Methods This prospective cohort study enrolled home‐based who requested an evaluation. allocated participants...

We provide an analysis of third-party sellers on Amazon’s online marketplace from a customer’s viewpoint. While Amazon as retailer sometimes directly competes with sellers, is also interested in making the attractive for and to customers. Based large-scale survey (n=772) customers U.S., we examine how much they like buy different seller types (Amazon itself, with/without Prime logo, i.e., Fulfillment by Amazon). Among other results, can show that logo side combined subscription customer...

Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little known about clinical hours worked financial compensation received by fellows during training. We sought describe duties EM at U.S. centers.

Objective: Food insecurity is a prevalent social risk among emergency department (ED) patients. Patients who may benefit from food resources be identified via ED-based screening; however, many patients experience difficulty accessing after discharge. Co-locating in or near the ED improve utilization by patients, but this approach remains largely unstudied. This study characterized acceptance and use of voucher redeemable at hospital market for screened positive during their visit. Methods:...

OBJECTIVES Despite early evidence of effectiveness, cost-savings, and resource optimization, mobile integrated health (MIH) programs have not been widely implemented in the United States. System, community, organizational-level barriers often hinder evidence-based public interventions, such as MIH programs, from being broadly adopted into real-world clinical practice. The objective this study is to identify solutions impeding implementation through interviews with multilevel stakeholders.

To evaluate procedural sedation (PS) in infants/children, performed by emergency physicians a general (nonpediatric) department (ED).Procedural prospectively recorded on standardized form over 15 years. Demographics, sedatives, and analgesia associations with adverse events were explored logistic regressions.Of 3274 consecutive PS, 1177 pediatric: 2 months to 21 years, mean age (±SD) 8.7 ± 5.2 63% boys, 717 White, 435 Black, 25 other. Eight hundred seventy American Society of Anesthesiology...

Background: While endotracheal intubation (ETI) is the most common prehospital advanced airway management technique in United States (US), observations from clinical trials and COVID-19 pandemic have motivated broader use of supraglottic airways (SGA). The current national patterns practices are unknown. We sought to describe longitudinal trends Emergency Medical Services (EMS) US. Methods: analyzed 2011-2021 data ESO, a set US electronic health records. identified all 911 events with...