New Practices in Emergency Medical Services - Research Paper Example

? New Practices in EMS The essay aims to address a two-fold objective to wit to research new or unique practices in EMS using multiple sources which may include scholarly medical and/or professional journals, direct interviews, seminars, legislative/regulatory websites, and Best Practices papers; and (2) to use formatting consistent with higher-level scholastic works. New Practices in EMS Every day, a number of people are being brought in the hospital to receive emergency services. To achieve a more quality of life, these emergency services are being modified from time to time with the help of research and development. The new or unique practices in Emergency Medical Services (EMS) may come from accredited scholarly medical and/or professional journals, direct interviews of allied professionals, recent seminars, best practices papers, and up-to-date legislative/regulatory websites. To cite examples, the author has gathered new practices in EMS from scholarly medical and/or professional journals with focus on the following areas: cardiopulmonary resuscitation, triage of agitated patients, U.S. fire service, and trends in pre-notification for acute ischemic stroke. The study of Lerner et al. (2012) revealed that most communities from out-of-hospital cardiac arrest (OHCA) in the United States and Canada have a survival rate of only 5 to 10% - a significantly lower percentage compared to the target 20% to 50% survival rates of communities with strong “Chain of Survival” (1). The current American Heart Association guideline for EMS dispatch for an adult who collapses suddenly recommends the following: immediate call to the local emergency response number of the bystander who happens to see an unresponsive patient; appropriate training of dispatchers for CPR pre-arrival instructions, recognition of abnormal or normal breathing, identification of cardiac arrest, initiation of CPR, and recommendation of CPR for unresponsive patients; and review of the performance of dispatcher CPR instructions by the EMS system quality-improvement process (Lerner, et al., 2012, 2). The researchers of the study believed that the systematic interrogation of all the callers, timely and appropriate instructions, and frequent monitoring could strengthen EMS and Chain of Survival; thus, more lives from OHCA will be safe and be back to their quality life. Meanwhile, Nordstrom et al. (2012) generally agreed on the Best Practices in the Evaluation and Treatment of Agitation in the emergency setting (BETA) (3). Agitation could be of medical or psychiatric condition and emergency services are required to triage agitated patients. However, to improve best practices, a few actions are recommended to foster best practices. Among of these practices: include exclusion of routine laboratory testing as the directed testing would identify the most likely causes of agitation, presuming new-onset agitation from a general medical condition, and alertness and suspicion of agitation from patients with immunosuppression. Just like the Chain of Survival link system, the success of this triage system in agitated patients lies on timely and well-followed algorithm of care. When agitation is suspected, medical evaluation by a clinician is immediately needed. Oxygenation, blood sugar level, and initial examination are directed to identify factors that would lead to life-threatening conditions. De-escalation is also necessary to maximize the full cooperation of the client. Once de-escalation has been achieved, it is now the time to identify underlying psychiatric conditions, proceed to routine management, and provide emergency medical services. Another study from Lin et al. (2012) highlights the current patterns, predictors, variations, and temporal trends in emergency medical service hospital pre-notification for acute ischemic stroke and noted that the pre-notification is a recommended strategy to improve timeliness of stroke treatment and evaluation (1). This has been supported by the National Association of Emergency Medical Services Physicians throughout the United States. The EMS pre-notification system seems to have been underutilized in contemporary settings. This is probably because of disparities in use, demographic factors, hospital factors, and comorbidities. Hospitals and policymakers are continuously re-evaluating the process of pre-notification across all boundaries to address the disparities and improve the timeliness and treatment of ischemic stroke. Thus, the study recommends the adoption of EMS pre-notification practices to facilitate faster imaging and interpretation, increase eligibility, administration, and rates of tPA. The study also revealed areas to be improved in terms of stroke treatment. This is because approximately one-third of all EMS-transported patients do not receive the benefits of pre-notification in different hospitals, states, and regional levels. The disparities brought by demographic factors must be addressed promptly in order to improve treatment of stroke and advance healthcare equity. Thus, Lin et al. (2012) target initiatives to improve the national rate of EMS notification, among of which include: awareness of the benefits of pre-notification and existing disparities in its use among EMS personnel, stroke teams, and receiving hospitals; emphasis on the importance of minimum threshold definition for stroke in EMS training; and reporting the use of EMS pre-notification and devising a stroke system-of-care process. However, despite the recommendations of different guidelines and potential benefits, EMS pre-notification was fully implemented and maximized. The last research is from Pessemier and England (2012) which study the comprehensive model of EMS or the safety culture for the U.S. fire service (10). The incidence of firefighter injury and fatality rates in U.S. is six times higher compared to other industrialized nations and the need for emergency services is highly demanded. The persistence of these injuries are seemingly attributed to the organizational culture on institutional change and performance or the collective practices, beliefs, and values of the organization in terms of safety performance. Thus, the need to improve EMS services in this population will require a change in the organizational culture itself. The study about firefighter injury and fatality rates in U.S. aims to provide a model for ensuring safety and providing emergency medical services at organizational level. This can be done by studying the organization’s culture, performance, and perspective about safety. Dimensions have been identified in the research to understand underlying organizational safety culture but nor research could support the causalities and safety culture. Results from the study supports the hypothesis that individual perceptions of safety management and safety behavior predicts individual perceptions of safety climate and need for EMS. Awareness and education must be inculcated among individuals to facilitate change in view of safety climate and introduce EMS. The study also recommends designing of tools to identify organizational strengths and weaknesses, safety culture model, provision of EMS, and creation of safety report cards and survey data. References Lerner, E.B. et al. (2012). Emergency Medical Service Dispatch Cardiopulmonary Resuscitation Prearrival Instructions to Improve Survival From Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. American Heart Association, 1-8. DOI: 10.1161/CIR.0b013e31823ee5fc. Lin, C.B. et al. . (2012). Patterns, Predictors, Variations, and Temporal Trends in Emergency Medical Service Hospital Prenotification for Acute Ischemic Stroke. Journal of the American Heart Association, 1, 1-16. Nordstrom, K. et al. (2012). Medical Evaluation and Triage of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup. Western Journal of Emergency Medicine, XIII(1), 3-10. Pessemier, W.L. and England, R.E. (2012). Safety culture in the US fire service: an empirical definition. International Journal of Emergency Services, 1, 10-28. Read More