- Email: [email protected]
Patterns in complaints field by the public against paramedics in an urban emergency medical services (EMS) system
RESEARCH
FORUM ABSTRACTS
insertion attempts by paramedics, of which 30 (81,1%) were successful. Mean insertion time for successful attempts was 64.36_+2.1 seconds, and the mean recorded gravity flow rate was 23.0_+9.8 mL/min. One infnsion achieved a rate of 100 mL/h with a pressure bag. Common resuscitation drugs, including epinephrine, atropine, fidocaine, bretylium, and 25% dextrose solution were successfully infused. Complications seen in successfully inserted devices included minor leakage of fluid at site (5), kinking of the infusion tubing (2), difficulty with device removal (3), and poor adhesion of the target/stabilization patch (5). Information on failed attempts is included in the Table. Conclusion: Vascuiar access was achieved in 81.1% of patients with adequate flow rates to serve as a primary line for drug and fluid infusion in cardiac arrest. The FAST-1 device may be a useful alternative means of achieving rapid intravenous access when difficulty is encountered m obtaining timely peripheral access in the prehospital setting.
Table, abstract 251.
254
Unsuccessful insertion attempts Patient
Comments
440 Ib; device deployed into presternal soft tissue 220 Ib; device did not deploy, infusion tubing in presternal soft tissue (probable operator error) 200 Lb; insertion attempted at "bad angle" deployed into presternaI soft tissue (operator error) 100 Ib; device did not deploy, "poor placement of patch," "never hit bone" 110 Ib; device did not deploy "Normal body fat"; device deployed but unable to infuse with syringe pressure; no infiltration 120 Ib; needles bent during insertion, noted "r/4-in stepoff in sternum" under insertion site.
12 21 23 27 32
52 Automated External Defibrillators Can Appropriately Recognize Ventricular Fibrillation in High Electromagnetic Fields StolzenbergBT, Kupas DF, Sole DP, WieczorekBJ/GeisingerMedical Center,Danville,PA Study objectives: Automated external defibrillators (AEDs) are increasingly available in industrial settings, but many industries have high electromagnetic fields (EMF), which can interfere with the function of electronic devices. This study evaluates the performance of several AEDs when exposed to high EMF. Methods: Three commercially available AEDs were evaluated in the setting of a public utility coal-fired electrical generation plant. Each AED was placed in 3 areas of high EMF ranging from 310 to 1,600 mG. A signal generator, used to simulate various cardiac rhythms, was connected to the AEDs. Rhythms simulated were ventricular fibrillation, asystole, and normal sinus rhythm. Each of the AED's interpretations of various rhythms were evaluated in the different EMP settings. Results: Rhythms of ventricular fibrillation, asystole, and normal sinus rhythm were correctly recognized by each AED in each of the 3 areas of high EMF. Each AED appropriately recommended defibrillation when presented with ventricular fibrillation No misinterpretations or inappropriate defibrillations were observed. Conclusion: EMF generated by an electrical power plant did not interfere with 3 commercial AEDs' abilities to correctly interpret simulated rhythms and recommend appropriate defibrillation.
53 Patterns in Complaints Filed by the Public Against Paramedics in an Urban Emergency Medical Services (EMS) System Pi RD, PensPT, MarkovchickV/Denver Health Medical Center, Denver,CO Study objective: The purpose of this study is threefold: (1) to identify the source of complaints, (2) to analyze the type of complaint, and (3) to quantify the complaints by season and year. Methods: A retrospective review of complaints on file at the Denver Health Paramedic Division for a 6-year period ending December 1998. Originators of complaints felt into 8 difM~nt groups, and the complaints were categorized as i2 major types All reviews were done by the pnncipal author. Results: The Denver Health Paramedic Division's annual field responses numbered about 50,000 (range 48, 771 to 53,733) The mean number of complaints per year was 48 with a range from 24 to 78. There was no consistent pattern in total cam-
S66
plaints or annual complaint rate from year to year. Although the most complaints were registered in the summer in 3 of the 6 years studied, summer was also consistently the time of highest system demand as well. However, the warmer half of the year, spring/summer, accounted for a 67% higher rate of complaints (10/10,000 responses versus 6/10,000 responses). Patients generated 52% of the complaints. The next largest 2 groups, respectively, were medical personnel (19%) and family members (12%). The top 4 categories of complaints accounted for three quarters of the complaints: rudeAnappropriate behavior (24%), history/physical/technical sMfis (20%), disagreement with transport/destination (18%), and loss of belongings (13%). Conclusion: No prior study has evaluated the origms or scope of complaints made against emergency medical services personnel. This study documents an average complaint rate of 9 per 10,000 responses (standard deviation • per 10,000) during the study period. The identification of high dissatisfaction areas will allow targeting of paramedic training programs for improvement.
Prehospita, Evaluation of Patients With Suspected Stroke
EcksteinM, Kidwell C, Starkman S, Weems K/Universityof SouthernCalifornia,UCLAMedical Center, the LAPSSStudyGroup,LosAngeles,CA Study objective: To determine the extent of paramedic field evaluation of suspected acute stroke patients before implementation of a training program on stroke recognition and treatment. Methods: This retrospective study examined a consecutive series of all patients presumptively identified with an acute stroke by Los Angeles City Fire Department paramedics from January 1, 1996, through December 31,1996. Each emergency medical services report was evaluated to determine the patients' most common presenting signs and past medical history (PMH), and whether key elements were documented to determine patient eligibility for thrombolytic treatment as per new national guidelines. Results: There were 779 patients who met the study's inclusion criteria, vnth a mean age of 72 years (• years), of w h o m 430 (55%) were female. The most common PMH conditions included hypertension (49%), heart disease (30%), prior stroke (27%), and diabetes (13%). Eighty-eight (115) patients were found to be in atrial fibri.llation. The most common findings on physical examination were unilateral weakness (66%), altered level of consciousness (33%), facial droop (26%), and dysarthria (19%). Paramedics failed to document the time of onset or duration or symptoms in 621 (80%) cases; 273 (35%) had no blood glucose measurement; i i7 (15%) had no recorded Glasgow Coma Scale score, and 35 (4.5%) had no documented ECG. Conclusion: Although paramedics identified common presenting signs of acute stroke, additional training should stress documentation of the time of onset of symptoms to determine patients' eligibility for thrombolytic therapy and mandatory blood glucose measurement to rule out reversible causes.
2 5 5 '"' Impact of "Mesh Pits" on Medical Incidents at Mass Gatherings Janchar T, SamaddarR, Milzrnan O/GeorgetownUniversitySchoolof Medicine,Providence Hospital,Washington, DC Mass gatherings, such as concerts, where audience members participate in "meshing," a violent form of dancing involving pushing, shoving, kicking, crowd surfing, and stage diving, has the potential to dramatically increase injuries requiring evaluation and transport by medical personnel covering these events cmnpamd with n o n - m e s h pit events. Study objective: To compare the rate and type of injuries, and rate of patient transport at mass events with mesh pits with mass events without mesh pits. Methods: A prospective study collected data from 4 events with mesh pits and compared the data with 6 n o n - m e s h pit events held at the same outdoor s t a d m m Student t test and Z 2 analysis were used with a value of P<.05. Results: There was an average attendance of 63,030 persons at the mesh pit events with a total attendance of 252,!.20 over the 4 event days. There was an average attendance of 39,244 persons at the n o n - m e s h pit events with a total attendance of 235,469 persons over the 6 event days. There were a total of 1,542 medical incidents at the mesh pit events with 30% (466) of these incidents being directly related to meshing. The average age was 21.0 years with 60% being female. A total of 39 persons needed hospital transport for further care; 29 (74%) of these had injuries directly related to mesh pit activity. At the n o n - m e s h pit events, there were a total of 180 medical incidents. The average age was 29.3 years with 56% being female. A total of 5 persons needed transport at the n o n - m e s h pit events. There was a higher rate of medical incidents at the mesh pit events with a total incident rate at these events of 61.1
ANNALS OF EMERGENCY MEDICINE 34:4 OCTOBER 1999, PART 2
FORUM ABSTRACTS
insertion attempts by paramedics, of which 30 (81,1%) were successful. Mean insertion time for successful attempts was 64.36_+2.1 seconds, and the mean recorded gravity flow rate was 23.0_+9.8 mL/min. One infnsion achieved a rate of 100 mL/h with a pressure bag. Common resuscitation drugs, including epinephrine, atropine, fidocaine, bretylium, and 25% dextrose solution were successfully infused. Complications seen in successfully inserted devices included minor leakage of fluid at site (5), kinking of the infusion tubing (2), difficulty with device removal (3), and poor adhesion of the target/stabilization patch (5). Information on failed attempts is included in the Table. Conclusion: Vascuiar access was achieved in 81.1% of patients with adequate flow rates to serve as a primary line for drug and fluid infusion in cardiac arrest. The FAST-1 device may be a useful alternative means of achieving rapid intravenous access when difficulty is encountered m obtaining timely peripheral access in the prehospital setting.
Table, abstract 251.
254
Unsuccessful insertion attempts Patient
Comments
440 Ib; device deployed into presternal soft tissue 220 Ib; device did not deploy, infusion tubing in presternal soft tissue (probable operator error) 200 Lb; insertion attempted at "bad angle" deployed into presternaI soft tissue (operator error) 100 Ib; device did not deploy, "poor placement of patch," "never hit bone" 110 Ib; device did not deploy "Normal body fat"; device deployed but unable to infuse with syringe pressure; no infiltration 120 Ib; needles bent during insertion, noted "r/4-in stepoff in sternum" under insertion site.
12 21 23 27 32
52 Automated External Defibrillators Can Appropriately Recognize Ventricular Fibrillation in High Electromagnetic Fields StolzenbergBT, Kupas DF, Sole DP, WieczorekBJ/GeisingerMedical Center,Danville,PA Study objectives: Automated external defibrillators (AEDs) are increasingly available in industrial settings, but many industries have high electromagnetic fields (EMF), which can interfere with the function of electronic devices. This study evaluates the performance of several AEDs when exposed to high EMF. Methods: Three commercially available AEDs were evaluated in the setting of a public utility coal-fired electrical generation plant. Each AED was placed in 3 areas of high EMF ranging from 310 to 1,600 mG. A signal generator, used to simulate various cardiac rhythms, was connected to the AEDs. Rhythms simulated were ventricular fibrillation, asystole, and normal sinus rhythm. Each of the AED's interpretations of various rhythms were evaluated in the different EMP settings. Results: Rhythms of ventricular fibrillation, asystole, and normal sinus rhythm were correctly recognized by each AED in each of the 3 areas of high EMF. Each AED appropriately recommended defibrillation when presented with ventricular fibrillation No misinterpretations or inappropriate defibrillations were observed. Conclusion: EMF generated by an electrical power plant did not interfere with 3 commercial AEDs' abilities to correctly interpret simulated rhythms and recommend appropriate defibrillation.
53 Patterns in Complaints Filed by the Public Against Paramedics in an Urban Emergency Medical Services (EMS) System Pi RD, PensPT, MarkovchickV/Denver Health Medical Center, Denver,CO Study objective: The purpose of this study is threefold: (1) to identify the source of complaints, (2) to analyze the type of complaint, and (3) to quantify the complaints by season and year. Methods: A retrospective review of complaints on file at the Denver Health Paramedic Division for a 6-year period ending December 1998. Originators of complaints felt into 8 difM~nt groups, and the complaints were categorized as i2 major types All reviews were done by the pnncipal author. Results: The Denver Health Paramedic Division's annual field responses numbered about 50,000 (range 48, 771 to 53,733) The mean number of complaints per year was 48 with a range from 24 to 78. There was no consistent pattern in total cam-
S66
plaints or annual complaint rate from year to year. Although the most complaints were registered in the summer in 3 of the 6 years studied, summer was also consistently the time of highest system demand as well. However, the warmer half of the year, spring/summer, accounted for a 67% higher rate of complaints (10/10,000 responses versus 6/10,000 responses). Patients generated 52% of the complaints. The next largest 2 groups, respectively, were medical personnel (19%) and family members (12%). The top 4 categories of complaints accounted for three quarters of the complaints: rudeAnappropriate behavior (24%), history/physical/technical sMfis (20%), disagreement with transport/destination (18%), and loss of belongings (13%). Conclusion: No prior study has evaluated the origms or scope of complaints made against emergency medical services personnel. This study documents an average complaint rate of 9 per 10,000 responses (standard deviation • per 10,000) during the study period. The identification of high dissatisfaction areas will allow targeting of paramedic training programs for improvement.
Prehospita, Evaluation of Patients With Suspected Stroke
EcksteinM, Kidwell C, Starkman S, Weems K/Universityof SouthernCalifornia,UCLAMedical Center, the LAPSSStudyGroup,LosAngeles,CA Study objective: To determine the extent of paramedic field evaluation of suspected acute stroke patients before implementation of a training program on stroke recognition and treatment. Methods: This retrospective study examined a consecutive series of all patients presumptively identified with an acute stroke by Los Angeles City Fire Department paramedics from January 1, 1996, through December 31,1996. Each emergency medical services report was evaluated to determine the patients' most common presenting signs and past medical history (PMH), and whether key elements were documented to determine patient eligibility for thrombolytic treatment as per new national guidelines. Results: There were 779 patients who met the study's inclusion criteria, vnth a mean age of 72 years (• years), of w h o m 430 (55%) were female. The most common PMH conditions included hypertension (49%), heart disease (30%), prior stroke (27%), and diabetes (13%). Eighty-eight (115) patients were found to be in atrial fibri.llation. The most common findings on physical examination were unilateral weakness (66%), altered level of consciousness (33%), facial droop (26%), and dysarthria (19%). Paramedics failed to document the time of onset or duration or symptoms in 621 (80%) cases; 273 (35%) had no blood glucose measurement; i i7 (15%) had no recorded Glasgow Coma Scale score, and 35 (4.5%) had no documented ECG. Conclusion: Although paramedics identified common presenting signs of acute stroke, additional training should stress documentation of the time of onset of symptoms to determine patients' eligibility for thrombolytic therapy and mandatory blood glucose measurement to rule out reversible causes.
2 5 5 '"' Impact of "Mesh Pits" on Medical Incidents at Mass Gatherings Janchar T, SamaddarR, Milzrnan O/GeorgetownUniversitySchoolof Medicine,Providence Hospital,Washington, DC Mass gatherings, such as concerts, where audience members participate in "meshing," a violent form of dancing involving pushing, shoving, kicking, crowd surfing, and stage diving, has the potential to dramatically increase injuries requiring evaluation and transport by medical personnel covering these events cmnpamd with n o n - m e s h pit events. Study objective: To compare the rate and type of injuries, and rate of patient transport at mass events with mesh pits with mass events without mesh pits. Methods: A prospective study collected data from 4 events with mesh pits and compared the data with 6 n o n - m e s h pit events held at the same outdoor s t a d m m Student t test and Z 2 analysis were used with a value of P<.05. Results: There was an average attendance of 63,030 persons at the mesh pit events with a total attendance of 252,!.20 over the 4 event days. There was an average attendance of 39,244 persons at the n o n - m e s h pit events with a total attendance of 235,469 persons over the 6 event days. There were a total of 1,542 medical incidents at the mesh pit events with 30% (466) of these incidents being directly related to meshing. The average age was 21.0 years with 60% being female. A total of 39 persons needed hospital transport for further care; 29 (74%) of these had injuries directly related to mesh pit activity. At the n o n - m e s h pit events, there were a total of 180 medical incidents. The average age was 29.3 years with 56% being female. A total of 5 persons needed transport at the n o n - m e s h pit events. There was a higher rate of medical incidents at the mesh pit events with a total incident rate at these events of 61.1
ANNALS OF EMERGENCY MEDICINE 34:4 OCTOBER 1999, PART 2