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AHRQ Research Studies Date
Topics
- Access to Care (1)
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- (-) Emergency Medical Services (EMS) (8)
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- Stroke (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 8 of 8 Research Studies DisplayedUrdaneta A, Fisk C, Tandel MD
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
This study examined patterns of air transport for acute ischemic stroke patients over a period of 8 years (2007-2014). The authors abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). They analyzed data from 149,751 hospitalized stroke patients who had a mean age of 81.6 years (standard deviation = 8.0 years), 62.1% female (n = 93,007), and 86.3% White (n = 129,268). Of these, 3.7% used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68 and OR = 0.34, respectively) and all racial minorities except American Natives (OR = 2.07) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23) and rural residents (OR = 1.34). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57).
AHRQ-funded; HS026207.
Citation: Urdaneta A, Fisk C, Tandel MD .
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
Air Med J 2023 Nov-Dec; 42(6):423-28. doi: 10.1016/j.amj.2023.06.007..
Keywords: Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Russell A, Jenkins JL, Zhang A
A review of infectious disease epidemiology in emergency medical service clinicians.
This review synthesized existing literature on the prevalence, incidence, and severity of infections in emergency medical service (EMS) workforce personnel. The majority of studies that met the inclusion criteria were focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and Hepatitis C also featured in a small number of studies. In the studies that compared infection rates between EMS clinicians and firefighters, EMS clinicians had a higher chance of hospitalization or death from SAR-CoV-2, a higher prevalence of Hepatitis C, and no significant differences in MRSA colonization. The authors concluded that more research was needed to characterize the incidence and severity of occupationally acquired infections in the EMS workforce.
AHRQ-funded; 75Q80120D00003.
Citation: Russell A, Jenkins JL, Zhang A .
A review of infectious disease epidemiology in emergency medical service clinicians.
Am J Infect Control 2023 Aug; 51(8):931-37. doi: 10.1016/j.ajic.2022.12.001..
Keywords: Infectious Diseases, Emergency Medical Services (EMS)
Kman NE, Price A, Berezina-Blackburn V
First Responder Virtual Reality Simulator to train and assess emergency personnel for mass casualty response.
This paper describes the First Responder Virtual Reality Simulator, a high-fidelity, fully immersive, automated, programmable virtual reality (VR) simulation designed to train frontline responders to treat and triage victims of mass casualty incidents. First responder trainees wear a wireless VR head-mounted display linked to a compatible desktop computer. Autonomous, interactive victims who are programmed to simulate individuals with injuries consistent with an explosion in an underground space are used. The trainees are armed with a virtual medical kit, who are then tasked with triaging and treating the victims on the scene. Increased challenges can be added such as increasing the environmental chaos, adding patients, or increasing the acuity of patient injuries.
AHRQ-funded; HS025915.
Citation: Kman NE, Price A, Berezina-Blackburn V .
First Responder Virtual Reality Simulator to train and assess emergency personnel for mass casualty response.
J Am Coll Emerg Physicians Open 2023 Feb;4(1):e12903. doi: 10.1002/emp2.12903.
Keywords: Emergency Medical Services (EMS), Simulation, Health Information Technology (HIT), Training, Emergency Preparedness
Govindarajan P, Shiboski S, Grimes B
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Investigators sought to determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Studying two urban counties in the western region of US that regionalized acute stroke care, they found that in Santa Clara County, intravenous alteplase was administered to 1.7% of patients in the pre-regionalization period and 2.1% in the post-regionalization period, while in San Mateo County, the numbers were 1.3% and 3.2%, respectively. In the post-regionalization phase, San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers, and more frequent use of intravenous alteplase at stroke centers. They concluded that greater post-regionalization improvements in San Mateo County contributed to significantly improved county-level thrombolysis use than Santa Clara County.
AHRQ-funded; HS026207; HS017965.
Citation: Govindarajan P, Shiboski S, Grimes B .
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Prehosp Emerg Care 2020 Jul-Aug;24(4):505-14. doi: 10.1080/10903127.2019.1679303..
Keywords: Stroke, Cardiovascular Conditions, Urban Health, Access to Care, Emergency Medical Services (EMS), Critical Care
Panchal AR, Finnegan G, Way DP
Assessment of paramedic performance on difficult airway simulation.
The purpose of this study was to assess paramedic comprehensive airway management practices during a difficult airway simulation through which paramedics were obligated to consider alternatives to endotracheal intubation (ETI). The investigators concluded that in a difficult airway management scenario designed for low ETI success rates, even experienced paramedics were challenged with comprehensive airway management. This was exemplified by difficulties with the use of backup airway devices.
AHRQ-funded; HS021456.
Citation: Panchal AR, Finnegan G, Way DP .
Assessment of paramedic performance on difficult airway simulation.
Prehosp Emerg Care 2020 May-Jun;24(3):411-20. doi: 10.3109/10903127.2015.1102993..
Keywords: Simulation, Emergency Medical Services (EMS), Training, Quality of Care, Care Management, Provider Performance
Stangenes SR, Painter IS, Rea TD
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
The objective of this study was to test if caller descriptions of chief complaint delays emergency medical dispatchers' (EMDs) recognition of the need for telephone-assisted CPR (T-CPR). The investigators conducted an analysis of N = 433 cardiac arrest calls from six large call centers in the United States. They concluded that caller chief complaint description affected the time to recognition of the need for T-CPR.
AHRQ-funded; HS021658.
Citation: Stangenes SR, Painter IS, Rea TD .
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
Resuscitation 2020 Apr;149:82-86. doi: 10.1016/j.resuscitation.2020.02.013..
Keywords: Emergency Medical Services (EMS), Cardiovascular Conditions, Patient Safety, Quality of Care, Telehealth, Health Information Technology (HIT), Communication
Sobieraj DM, Martinez BK, Miao B
Comparative effectiveness of analgesics to reduce acute pain in the prehospital setting.
The objectives of this study were to assess comparative effectiveness and harms of opioid and nonopioid analgesics for the treatment of moderate to severe acute pain in the prehospital setting. Among the investigators’ conclusions were that as initial analgesia, opioids were no different than ketamine, APAP, and NSAIDs in reducing acute pain in the prehospital setting. Opioids may cause fewer total side effects than ketamine, but more than APAP or NSAIDs.
AHRQ-funded; 290201500012I.
Citation: Sobieraj DM, Martinez BK, Miao B .
Comparative effectiveness of analgesics to reduce acute pain in the prehospital setting.
Prehosp Emerg Care 2020 Mar-Apr;24(2):163-74. doi: 10.1080/10903127.2019.1657213..
Keywords: Opioids, Medication, Pain, Emergency Medical Services (EMS), Comparative Effectiveness, Patient-Centered Outcomes Research
Zive D, Newgard CD, Lin A
Injured older adults transported by emergency medical services: one year outcomes by POLST status.
Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. This study examined one year outcomes, by Physician Orders for Life-Sustaining Treatment status, of injured adults transported by EMS. The investigators concluded that among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year.
AHRQ-funded; HS023796.
Citation: Zive D, Newgard CD, Lin A .
Injured older adults transported by emergency medical services: one year outcomes by POLST status.
Prehosp Emerg Care 2020 Mar-Apr;24(2):257-64. doi: 10.1080/10903127.2019.1615154..
Keywords: Elderly, Injuries and Wounds, Emergency Medical Services (EMS), Emergency Department