INNOVATIONS UNDERWAY Responses from the PIE Survey
bystander CPR by 14%. 11 Data sharing will allow agencies to monitor CPR quality and track clinical outcomes, while improving cardiac arrest research. EMS agencies are also exploring collaborations with organ donation centers to assist families who may be interested in organ donation following a cardiac arrest has been pronounced in the field. This example shows how an integrated EMS workforce can have an impact on areas of medicine that are not traditionally seen as part of the EMS role. performing hospital pre-notification from the field have all played an important role in expediting door to needle (DTN) and door to thrombolytic times. Despite such interventions, the median times remain greater than 60 minutes. 12 To achieve further gains, there may be ways to leverage technology to improve the pre-notification process or to accelerate diagnostic imaging through direct to CT protocols. Given new literature on the benefits of endovascular procedures, 13, 14 and comprehensive stroke centers (CSCs), 15 EMS systems need to revisit their approach to hospital destination decisions. Distinguishing which patients are appropriate for direct transport to CSCs is challenging without novel or improved EMS prehospital stroke scales to detect large vessel occlusions. Alternatively, some hospital systems and EMS agencies have turned to innovative technologies, namely telehealth and/ or mobile stroke units (MSU) equipped with a CT Stroke Creating regionalized systems of care, and
Survey respondents pointed to the following projects that they are currently pursuing:
envelope and enabling the development and testing of new treatments or delivery models that result in better outcomes for patients. Cardiac Arrest EMS has found exciting new applications of technology and data sharing to improve cardiac arrest survival rates. Apps that notify the public of nearby cardiac arrests have increased rates of • X-rays/Ultrasound on the ambulance • Integrating AED location data into CAD system and notifying bystanders • Sepsis pathway (blood cultures, lactate, & antibiotics) • Video interface (telehealth) with: º ED physician º Primary care physician º Trauma surgeon (follow-up) • Referral programs to: º Home health º Social services º Mental health services • Emergency preparedness training for vulnerable populations • EMS supporting “Directly Observed Therapy” (DOT) programs for TB patients • Direct transport to: º Sobering centers
11 Ringh, Mattias, Mårten Rosenqvist, Jacob Hollenberg, Martin Jonsson, David Fredman, Per Nordberg, Hans Järnbert-Pettersson, Ingela Hasselqvist-Ax, Gabriel Riva, and Leif Svensson. “Mo bile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest.” New England Journal of Medicine 372, no. 24 (2015): 2316-2325. 12 Fonarow, Gregg C., Xin Zhao, Eric E. Smith, Jeffrey L. Saver, Mathew J. Reeves, Deepak L. Bhatt, Ying Xian, Adrian F. Hernandez, Eric D. Peterson, and Lee H. Schwamm. “Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative.” Jama 311, no. 16 (2014): 1632-1640. 13 Berkhemer, Olvert A., Puck SS Fransen, Debbie Beumer, Lucie A. Van Den Berg, Hester F. Lingsma, Albert J. Yoo, Wouter J. Schonewille et al. “A randomized trial of intraarterial treatment for acute ischemic stroke.” New England Journal of Medicine 372, no. 1 (2015): 11-20. 14 Goyal, Mayank, Andrew M. Demchuk, Bijoy K. Menon, Muneer Eesa, Jeremy L. Rempel, John Thornton, Daniel Roy et al. “Randomized assessment of rapid endovascular treatment of ischemic stroke.” New England Journal of Medicine 372, no. 11 (2015): 1019-1030. 15 McKinney, James S., Jerry Q. Cheng, Igor Rybinnik, and John B. Kostis. “Comprehensive stroke centers may be associated with improved survival in hemorrhagic stroke.” Journal of the American Heart Association 4, no. 5 (2015): e001448.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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