Association of Burnout with Workforce-Reducing Factors among EMS Professionals

Objectives: Emergency medical services (EMS) professionals often work long hours at multiple jobs and endure frequent exposure to traumatic events. The stressors inherent to the prehospital setting may increase the likelihood of experiencing burnout and lead providers to exit the profession, representing a serious workforce and public health concern. Our objectives were to estimate the prevalence of burnout, identify characteristics associated with experiencing burnout, and quantify its relationship with factors that negatively impact EMS workforce stability, namely sickness absence and turnover intentions. Methods: A random sample of 10,620 emergency medical technicians (EMTs) and 10,540 paramedics was selected from the National EMS Certification database to receive an electronic questionnaire between October, 2015 and November, 2015. Using the validated Copenhagen Burnout Inventory (CBI), we assessed burnout across three dimensions: personal, work-related, and patient-related. We used multivariable logistic regression modeling to identify burnout predictors and quantify the association between burnout and our workforce-related outcomes: reporting ten or more days of work absence due to personal illness in the past 12 months, and intending to leave an EMS job or the profession within the next 12 months. Results: Burnout was more prevalent among paramedics than EMTs (personal: 38.3% vs. 24.9%, work-related: 30.1% vs. 19.1%, and patient-related: 14.4% vs. 5.5%). Variables associated with increased burnout in all dimensions included certification at the paramedic level, having between five and 15 years of EMS experience, and increased weekly call volume. After adjustment, burnout was associated with over a two-fold increase in odds of reporting ten or more days of sickness absence in the past year. Burnout was associated with greater odds of intending to leave an EMS job (personal OR:2.45, 95% CI:1.95–3.06, work-related OR:3.37, 95% CI:2.67–4.26, patient-related OR: 2.38, 95% CI:1.74–3.26) or the EMS profession (personal OR:2.70, 95% CI:1.94–3.74, work-related OR:3.43, 95% CI:2.47–4.75, patient-related OR:3.69, 95% CI:2.42–5.63). Conclusions: The high estimated prevalence of burnout among EMS professionals represents a significant concern for the physical and mental well-being of this critical healthcare workforce. Further, the strong association between burnout and variables that negatively impact the number of available EMS professionals signals an important workforce concern that warrants further prospective investigation.     

Binge drinking trends in a UK community‐based sample

Aims To investigate binge drinking trends using unrelated singletons from the GENESiS sample, aged 20–60 years.

Methods The GENESiS study is a questionnaire study based in the UK and includes measures on various mental health items as well as measures of alcohol consumption. Alcohol data from 20?062 subjects were analysed with respect to binge/heavy drinking behaviour as defined by the Office for National Statistics, UK.

Results The average number of units of alcohol per week consumed was 16 for men and 8 for women. Female binge drinking (more than 6 units per drinking session) was found to be very comparable to male binge drinking (more than 8 units per drinking session) with 15% of males reporting binge drinking compared with 18% of females. Binge drinking was found to be most prevalent amongst males and females in their twenties (33% of males vs 38% of females).

Conclusions This study revealed that, for both men and women, there was evidence of substantial numbers drinking heavily and in a binge drinking pattern, particularly in young adults.     

Agreement between emergency medical services and expert blood pressure measurements

Background

Emergency Medical Services (EMS)-measured blood pressures (BPs) are utilized for administering medications in the field and for triage decisions. Retrospective work has demonstrated poor agreement between EMS and Emergency Department (ED) BP but has lacked a valid, reliable reference standard.

Study Objectives

To compare EMS BP measurements with those of trained research assistants (RA) and observe measurement technique for sources of error.

Methods

A prospective study was performed with a large urban EMS. BP measurements were made by RA within 5 min of patients presenting to the ED. EMS personnel were asked about technique. EMS personnel were then observed while RA simultaneously measured BP. Analysis was performed using methods outlined by Bland and Altman.

Results

There were 100 patients enrolled for each phase. In the first phase, the mean difference in systolic BP was −3.8 ± 18.6 mm Hg (95% confidence interval [CI] −8.3 to 0.59), and the mean difference in diastolic BP was 0.42 ± 13.8 mm Hg (95% CI −3.3 to 4.1). In the second phase, the mean difference in systolic BP was −4.6 ± 10.1 mm Hg (95% CI −6.6 to −2.6) and the mean difference in diastolic BP was −3.6 ± 10.6 mm Hg (95% CI −3.6 to −0.2). EMS personnel failed to properly place the cuff or deflate it 2–3 mm Hg/s in over 90% of the readings. They failed to properly inflate the cuff in 74% of the patients, and failed to properly place the stethoscope in 40%. EMS personnel demonstrated a significant preference for the terminal digit of “0” (p < 0.0001).

Conclusions

EMS and expert BP measurements showed smaller discrepancies than those previously noted, especially with simultaneous measurements. However, EMS demonstrated poor adherence to American Heart Association recommendations for measuring BP. EMS also showed terminal digit preference.     

Occupational Injuries and Exposures among Emergency Medical Services Workers

Objective: Emergency medical services (EMS) workers incur occupational injuries at a higher rate than the general worker population. This study describes the circumstances of occupational injuries and exposures among EMS workers to guide injury prevention efforts. Methods: The National Institute for Occupational Safety and Health collaborated with the National Highway Traffic Safety Administration to conduct a follow-back survey of injured EMS workers identified from a national sample of hospital emergency departments (EDs) from July 2010 through June 2014. The interviews captured demographic, employment, and injury event characteristics. The telephone interview data were weighted and are presented in the results as national estimates and rates. Results: Telephone interviews were completed by 572 EMS workers treated in EDs, resulting in a 74% cooperation rate among all EMS workers who were identified and successfully contacted. Study respondents represented 89,100 (95% CI 54,400–123,800) EMS workers who sought treatment in EDs over the four-year period. Two-thirds were male (59,900, 95% CI 35,200–84,600) and 42% were 18–29 years old (37,300, 95% CI 19,700–54,700). Three-quarters of the workers were full-time (66,800, 95% CI 39,800–93,800) and an additional 10% were part-time or on-call (9,300, 95% 4,900–13,700). Among career EMS workers, the injury rate was 8.6 per 100 full-time equivalent EMS workers (95% CI 5.3–11.8). Over half of all injured workers had less than ten years of work experience. Sprains and strains accounted for over 40% of all injuries (37,000, 95% CI 22,000–52,000). Body motion injuries were the leading event (24,900, 95% CI 14,900–35,000), with 90% (20,500, 95% CI 12,800–32,100) attributed to lifting, carrying, or transferring a patient and/or equipment. Exposures to harmful substances were the second leading event (24,400, 95% CI 11,700–37,100). Conclusion: New and enhanced efforts to prevent EMS worker injuries are needed, especially those aimed at preventing body motion injuries and exposures to harmful substances. EMS and public safety agencies should consider adopting and evaluating injury prevention measures to improve occupational safety and promote the health, performance, and retention of the EMS workforce.     

Factors Associated with Emergency Medical Services Scope of Practice for Acute Cardiovascular Events

Abstract

Objectives. To examine prehospital emergency medical services (EMS) scope of practice for acute cardiovascular events and characteristics that may affect scope of practice; and to describe variations in EMS scope of practice for these events and the characteristics associated with that variability. Methods. In 2008, we conducted a telephone survey of 1,939 eligible EMS providers in nine states to measure EMS agency characteristics, medical director involvement, and 18 interventions authorized for prehospital care of acute cardiovascular events by three levels of emergency medical technician (EMT) personnel. Results. A total of 1,292 providers responded to the survey, for a response rate of 67%. EMS scope of practice interventions varied by EMT personnel level, with the proportion of authorized interventions increasing as expected from EMT-Basic to EMT-Paramedic. Seven of eight statistically significant associations indicated that EMS agencies in urban settings were less likely to authorize interventions (odds ratios <0.7) for any level of EMS personnel. Based on the subset of six statistically significant associations, fire department–based EMS agencies were two to three times more likely to authorize interventions for EMT-Intermediate personnel. Volunteer EMS agencies were more than twice as likely as nonvolunteer agencies to authorize interventions for EMT-Basic and EMT-Intermediate personnel but were less likely to authorize any one of the 11 interventions for EMT-Paramedics. Greater medical director involvement was associated with greater likelihood of authorization of seven of the 18 interventions for EMT-Basic and EMT-Paramedic personnel but had no association with EMT-Intermediate personnel. Conclusions. We noted statistically significant variations in scope of practice by rural vs. urban setting, medical director involvement, and type of EMS service (fire department–based/non–fire department–based; volunteer/paid). These variations highlight local differences in the composition and capacity of EMS providers and offer important information for the transition towards the implementation of a national scope of practice model.     

Alcohol consumption among Australian nurses: A cross-sectional national survey study

BackgroundNurses are the largest profession within the health workforce. Limited available literature suggests high rates of alcohol consumption may occur among Australian nurses.AimTo determine the prevalence of high-risk alcohol consumption among Australian nurses.MethodsA cross-sectional national survey was distributed via professional groups and social media to Australian nurses. Participants provided demographic information and completed a modified Perceptions of Work Stress Scale. The 10-item Alcohol Use Disorders Identification Test (AUDIT) was used to explore nurses’ self-reported alcohol consumption. Surveys were conducted between July and October 2021.FindingsThe overall prevalence of risky drinking was 36.9% among participants; 26.1% at risky or hazardous levels, 5.6% at the high-risk or harmful level, and 5.1% at high-risk, almost certainly dependent levels. Correlations between work setting, stress, and risky alcohol consumption revealed nurses working in Emergency Departments were most likely to report higher perceived stress and AUDIT scores.DiscussionThe prevalence of high-risk alcohol consumption among Australian nurses was higher than previously reported. The COVID-19 pandemic emerged as a potential factor contributing to increased stress and alcohol consumption among Australian nurses.ConclusionGiven the current vulnerability in the nursing workforce, tailored interventions are urgently required to address high-risk alcohol consumption.     

Occupational Injuries among Emergency Medical Services Personnel

Background. Emergency medical services (EMS) personnel treat 22 million patients a year in the United States, yet little is known of their injury risks. Objectives. To describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, andcompare the findings with those for other occupational groups. Methods. This was a retrospective review of injury records kept by two urban agencies. The agencies submitted all 617 case reports for three periods between January 1, 1998, andJuly 15, 2002. The agency personnel worked an estimated 2,829,906 hours during the study periods. Cases were coded according to U.S. Department of Labor (DOL) criteria. Results. Four hundred eighty-nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5–37.6). “Sprains, strains, andtears” was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3–21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35–1.72) compared with firefighters, 5.8 (95% CI 5.12–6.49) compared with health services personnel, and7.0 (95% CI 6.22–7.87) compared with the national average. Conclusions. The injury rates for EMS workers are higher than rates reported by DOL for any industry in 2000. Funding andadditional research are critical to further defining the high risks to EMS workers anddeveloping interventions to mitigate this serious problem.     

Workplace Incivility Among Nationally Certified EMS Professionals and Associations with Workforce-Reducing Factors and Organizational Culture

Background: Incivility, defined as negative interpersonal acts that violate workplace and social norms, has been linked to negative outcomes in healthcare settings. A minimal amount is known regarding workplace incivility among emergency medical services (EMS) professionals. Our objectives were to (1) evaluate the prevalence of incivility and factors associated with experiencing workplace incivility; (2) describe the association between incivility and workforce-reducing factors (stress, career satisfaction, turnover intentions, and workplace absences); and (3) quantify the association between incivility and the organizational culture of an EMS agency. Methods: A random sample of 38,000 nationally-certified EMS professionals received an electronic questionnaire with an EMS-adapted Workplace Incivility Scale, the Competing Values Framework organizational culture scale, and factors that may negatively impact the EMS workforce. All completed surveys from nonmilitary EMS professionals currently providing patient care at the EMT level or higher were included in these analyses. We constructed multivariable logistic regression models (OR, 95% CI) to identify factors associated with experiencing workplace incivility and to examine the associations between experiencing incivility and workforce-reducing factors. We calculated univariable odds ratios to assess the association between organizational culture type and incivility. Results: A total of 3,741 EMS professionals responded to the survey (response rate =10.3%), with 2,815 (75.2%) meeting inclusion criteria. Incivility from supervisors or coworkers was experienced at least once a week by 47.4% of respondents. Factors associated with increased odds of experiencing incivility included female sex, AEMT/paramedic certification level, increasing years of EMS experience, service types other than 9-1-1 response, and higher weekly call volumes. Exposure to regular incivility was associated with increased odds of dissatisfaction with EMS, a main EMS job or a main supervisor; moderate or higher stress levels; intent to leave one’s job and EMS in the next 12 months; and 10 or more workplace absences in the past 12 months. The organizational culture type “market” was associated with the greatest odds of incivility. Conclusions: Nearly half of respondents experienced incivility once a week or more, and incivility was associated with potential workforce-reducing factors. Further research is needed to understand how organizational climate and interpersonal behaviors in the workplace affect the EMS workforce.     

Contemporary Prehospital Emergency Medical Services Response Times for Suspected Stroke in the United States

Background and Purpose: There are no contemporary national-level data on Emergency Medical Services (EMS) response times for suspected stroke in the United States (US). Because effective stroke treatment is time-dependent, we characterized response times for suspected stroke, and examined whether they met guideline recommendations. Methods: Using the National EMS Information System dataset, we included 911 calls for patients ≥ 18 years with an EMS provider impression of stroke. We examined variation in the total EMS response time by dispatch notification of stroke, age, sex, race, region, time of day, day of the week, as well as the proportion of EMS responses that met guideline recommended response times. Total EMS response time included call center dispatch time (receipt of call by dispatch to EMS being notified), EMS dispatch time (dispatch informing EMS to EMS starts moving), time to scene (EMS starts moving to EMS arrival on scene), time on scene (EMS arrival on scene to EMS leaving scene), and transport time (EMS leaving scene to reaching treatment facility). Results: We identified 184,179 events with primary impressions of stroke (mean age 70.4 ± 16.4 years, 55% male). Median total EMS response time was 36 (IQR 28.7–48.0) minutes. Longer response times were observed for patients aged 65–74 years, of white race, females, and from non-urban areas. Dispatch identification of stroke versus “other” was associated with marginally faster response times (36.0 versus 36.7 minutes, p < 0.01). When compared to recommended guidelines, 78% of EMS responses met dispatch delay of <1 minute, 72% met time to scene of <8 minutes, and 46% met on-scene time of <15 minutes. Conclusions: In the United States, time from receipt of 9-1-1 calls to treatment center arrival takes a median of 36 minutes for stroke patients, an improvement upon previously published times. The fact that 22%–46% of EMS responses did not meet stroke guidelines highlights an opportunity for improvement. Future studies should examine EMS diagnostic accuracy nationally or regionally using outcomes based approaches, as accurate recognition of prehospital strokes is vital in order to improve response times, adhere to guidelines, and ultimately provide timely and effective stroke treatment.     

Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest

Background and aim: The large regional variation in survival after treatment of out-of-hospital cardiac arrest (OHCA) is incompletely explained. Communities respond to OHCA with differing number of emergency medical services (EMS) personnel who respond to the scene. The effect of different numbers of EMS personnel on-scene upon outcomes is unclear. We sought to evaluate the association between number of EMS personnel on-scene and survival after OHCA.MethodsWe performed a retrospective review of prospectively collected data on 16,122 EMS-treated OHCA events from December 1, 2005 to May 31, 2007 from a combined population over 21 million people residing in an area of over 33,000 square miles in Canada and the United States. Number of EMS personnel on-scene was defined as the number of EMS personnel who responded to the scene of OHCA within 15 min after 9-1-1 call receipt and prior to patient death or transport away from the scene. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models.ResultsCompared to a reference number of EMS personnel on-scene of 5 or 6, 7 or 8 EMS personnel on-scene was associated with a higher rate of survival to hospital discharge, adjusted odds ratio [OR], 1.35 (95% CI: 1.05, 1.73). There was no significant difference in survival between 5 or 6 personnel on-scene versus fewer.ConclusionMore EMS personnel on-scene within 15 min of 9-1-1 call was associated with improved survival of out-of-hospital cardiac arrest. It is unlikely that this finding was mediated solely by earlier CPR or earlier defibrillation.     

Relationship of Restraint Use,Patient Injury,andAssaults on Ems Personnel

Objective. We hypothesized that the assaults on EMS personnel by patients requiring restraints can be correlated with demographic information, patient condition, andother scene information such as presence the of law enforcement. Methods. The study was a one-year cross-sectional study of paramedic restraint use andassault on EMS personnel in an urban area. A data collection form was completed by EMS for each patient placed in restraints. Study outcome variable was “Assault on EMS personnel.” Predictor variables included demographic andEMS call information, patient condition, law-enforcement related variables, andthe paramedic's perception of the need for chemical restraints. To compare predictor andoutcome variables, a multivariable model with odds ratios and95% confidence intervals was used. Results. The study included 271 restrained patients over a 12-month period from April 2002 to April 2003. Seventy-seven (28%) cases were positive for assaults on EMS personnel. Multivariable analysis including 8 variables, indicated the following 6 variables were associated with assault on EMS personnel: time of day between midnight and6 am (OR = 4.4, 95% CI = 1.6–12.7); female patient (OR for males 0.6, 95% CI = 0.3–1.0); violent patient (OR = 10.1, 95%CI = 2.3–48.2); patient injured under supervision (OR = 3.9, 95% CI = 1.1–13.8); arrested patient (OR = 4.4, 95% CI = 1.1–18.5); andperceived need for chemical restraint (OR = 2.1, 95% CI = 1.2–3.9). Conclusion. Multiple factors are correlated with assaults on EMS personnel by patients requiring restraints. By specifically targeting patients exhibiting these factors, EMS providers can help prevent injury to themselves. Patients not exhibiting these factors may be less dangerous.     

Hypoglycemia Patients and Transport by EMS in Alameda County, 2013–15

Objective: To estimate the rate, characteristics, and dispositions of hypoglycemia events among persons who received care from Alameda County, California, Emergency Medical Services (EMS). Methods: This study was based on data for 601,077 Alameda County EMS encounters during 2013–15. Subjects were defined as having hypoglycemia if EMS personnel recorded a primary impression of hypoglycemia or low blood glucose (<60 mg/dl or “unspecified low”). The outcome of interest was patient transport or non-transport to an emergency department or other care setting; we excluded 33,177 (6%) encounters which lacked clear disposition outcomes. Results: Among 567,900 eligible encounters, 8,332 (1.47%) were attributed to hypoglycemia, of which 1,125 (13.5%) were not transported. Non-transport was more likely among males, adult patients age <60, initial blood glucose >60 mg/dl or EMS arrival time 18:00–6:00. Conclusions: Without an understanding of EMS encounters and non-transport rates, surveillance based solely on emergency department and hospital data will significantly underestimate rates of severe hypoglycemia. Additionally, given that hypoglycemia is often safely and effectively treated by non-physicians, EMS protocols should provide guidance for non-transport of hypoglycemic patients whose blood glucose levels have normalized.     

Information Loss in Emergency Medical Services Handover of Trauma Patients

Introduction. Little is known about how effectively information is transferred from emergency medical services (EMS) personnel to clinicians in the emergency department receiving the patient. Information about prehospital events and findings can help ensure expedient and appropriate care. The trauma literature describes 16 prehospital data points that affect outcome and therefore should be included in the EMS report when applicable. Objective. To determine the degree to which information presented in the EMS trauma patient handover is degraded. Methods. At a level I trauma center, patients meeting criteria for the highest level of trauma team activation (“full trauma”) were enrolled. As part of routine performance improvement, the physician leadership of the trauma program watched all available video-recorded full trauma responses, checking off whether the data points appropriate to the case were verbally “transmitted” by the EMS provider. Two EMS physicians then each independently reviewed the trauma team's chart notes for 50% of the sample (and a randomly selected 15% of the charts to assess agreement) and checked off whether the same elements were documented (“received”) by the trauma team. The focus was on data elements that were “transmitted” but not “received.” Results. In 96 patient handovers, a total of 473 elements were transmitted, of which 329 were received (69.6%). On the average chart, 72.9% of the transmitted items were received (95% confidence interval 69.0%–76.8%). The most commonly transmitted data elements were mechanism of injury (94 times), anatomic location of injury (81), and age (67). Prehospital hypotension was received in only 10 of the 28 times it was transmitted; prehospital Glasgow Coma Scale [GCS] score 10 of 22 times; and pulse rate 13 of 49 times. Conclusions. Even in the controlled setting of a single-patient handover with direct verbal contact between EMS providers and in-hospital clinicians, only 72.9% of the key prehospital data points that were transmitted by the EMS personnel were documented by the receiving hospital staff. Elements such as prehospital hypotension, GCS score, and other prehospital vital signs were often not recorded. Methods of “transmitting” and “receiving” data in trauma as well as all other patients need further scrutiny.     

National Characteristics of Emergency Medical Services in Frontier and Remote Areas

Although much is known about EMS care in urban, suburban, and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. We linked the NEMSIS dataset with Economic Research Service-identified FAR areas, defined as a ZIP Code >60 minutes driving time to an urban center with >50,000 persons. We excluded EMS responses resulting in intercepts, standbys, inter-facility transports, and medical transports. Using odds ratios, t-tests and the Wilcoxon rank-sum test, we compared patient demographics, response characteristics (location type, level of care), clinical impressions, and on-scene death between EMS responses in FAR and non-FAR areas. There were 15,005,588 EMS responses, including 983,286 (7.0%) in FAR and 14,025,302 (93.0%) in non-FAR areas. FAR and non-FAR EMS events exhibited similar median response 5 [IQR 3–10] vs. 5 [3–8] min), scene (14 [10–20] vs. 14 [10–20] min), and transport times (11 [5.,24] vs. 12 [7,19] min). Air medical (1.51% vs. 0.42%; OR 4.15 [95% CI: 4.03–4.27]) and Advanced Life Support care (62.4% vs. 57.9%; OR 1.25 [1.24–1.26]) were more common in FAR responses. FAR responses were more likely to be of American Indian or Alaska Native race (3.99% vs. 0.70%; OR 5.04, 95% CI: 4.97–5.11). Age, ethnicity, location type, and clinical impressions were similar between FAR and non-FAR responses. On-scene death was more likely in FAR than non-FAR responses (12.2 vs. 9.6 deaths/1,000 responses; OR 1.28, 95% CI: 1.25–1.30). Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.     

Emergency Medical Services Education,Community Outreach,andProtocols for Stroke andChest Pain in North Carolina

Objective. Prehospital care of stroke andchest pain patients is dependent on adequate emergency medical services (EMS) education andevidence-based protocols. We sought to describe the amount of education offered, community outreach implemented, andprotocols established for stroke andfor chest pain among North Carolina EMS agencies andpersonnel. Methods. A survey was developed to measure EMS system characteristics regarding the prehospital care of stroke andchest pain patients. Each of the 83 primary EMS agencies in North Carolina was asked to participate. Results. Of the 83 agencies surveyed, 72 (87%) responded. Both advanced life support (ALS) andbasic life support (BLS) services were provided by 54% of agencies; 44% offered ALS only and1% offered BLS only. While 89% of the EMS agencies provided stroke education to EMS personnel and96% chest pain education to EMS personnel in the previous two years, the median hours devoted to stroke was one-half that for chest pain (6.0 vs. 12.0 hours, respectively). In the previous six months, 14% of EMS agencies had conducted community outreach programs for stroke compared with 17% for chest pain. The majority of EMS agencies had protocols specifically for managing stroke (83%) andfor managing chest pain (99%). Diagnostic scales to identify stroke patients were used by 54% of agencies (20% Los Angeles Prehospital Stroke Screen, 20% Cincinnati Prehospital Stroke Scale, and14% a locally developed scale). Thrombolytic checklists were used to identify eligible stroke patients at 37% of the EMS agencies, compared with 28% for eligible chest pain patients. Conclusions. In North Carolina, primary EMS agencies appear to have stroke andchest pain protocols in approximately the same frequency, yet their personnel receive only one-half as much education about stroke as they do about chest pain. Many stroke protocols were lacking basic components andwould benefit from standardization across the state. Community outreach programs for both stroke andchest pain are minimal.     

Accuracy of weight estimates in pediatric patients by prehospital Emergency Medical Services personnel

Objectives

Most medications administered to children are weight-based, and inaccurate weight estimation may contribute to medical errors. Previous studies have been limited to hypothetical patients and those in cardiopulmonary arrest. We aim to determine the accuracy of weight estimates by Emergency Medical Services (EMS) personnel of children receiving medications and to identify factors associated with accuracy.

Methods

EMS records of children < 18 years old receiving weight-based medications were merged with EMS staffing data and hospital records. The rate of accurate weight estimates, defined as a value within 20% of the actual weight, was evaluated as the primary outcome. Factors associated with patients and prehospital personnel were also evaluated.

Results

29 233 transports occurring during the study period were reviewed, and 199 transports of 179 children were analyzed. The average experience of EMS personnel was 35.8 months (SD ± 30.7). EMS personnel accurately estimated weights in 164/199 (82.4%) patients; estimated weights were within 10.8% (SD ± 10.5) of the actual weights. Underestimated weights were associated with receiving doses outside of the therapeutic range. Inaccurate weight estimates were associated with age less than 10 years or cardiopulmonary arrest. There was a trend toward inaccurate weight estimates among children who presented with seizures.

Conclusions

EMS personnel are generally accurate in estimating weights of children. There was an association between underestimated weights and inaccurate medication dosing. Younger children or those presenting with seizure or cardiopulmonary arrest were more likely to have inaccurate weight estimates.