ABSTRACT
BACKGROUND: EMS frequently encounter patients who decline transport, yet there are little data to inform the safety of patient and/or paramedic-initiated assess, treat, and refer (ATR) protocols. We determined patient decision-making and short-term outcomes after non-transport by EMS during the COVID-19 pandemic. METHODS: This was a prospective, observational study of a random sample of patients evaluated and not transported by EMS from August 2020 to March 2021. From the EMS database, we randomly selected a daily sample of adult patients with disposition of ATR. We excluded patients dispositioned against medical advice (AMA) and those in police custody. Investigators contacted patients by phone to administer a standardized survey regarding decision-making, symptom progression, follow-up care, and satisfaction with non-transport decision. We also determined the proportion of patients who re-contacted 9-1-1 within 72 h, and unexpected deaths within 72 h using coroner data. Descriptive statistics were calculated. RESULTS: Of 4613 non-transported patients, 3330 (72%) patients for whom the disposition was ATR were included. Patients were 46% male with a median age of 49 (inter-quartile range (IQR) 31-67). Median vital signs measurements fell within the normal range. Investigators successfully contacted 584/3330 patients (18%). The most common reason for failure was lack of accurate phone number. The most common reasons patients reported for not going to the ED on initial encounter were: felt reassured after the paramedic assessment (151/584, 26%), medical complaint resolved (113/584, 19%), paramedic suggested transport was not required (73/584, 13%), concern for COVID-19 exposure (57/584, 10%), and initial concern was not medical (46/584, 8%). Ninety-five percent (552/584) were satisfied with the non-transport decision and 49% (284/584) had sought follow-up care. The majority (501/584, 86%) reported equal, improved, or resolved symptoms, while 80 patients (13%) reported worse symptoms, of whom (64/80, 80%) remained satisfied with the non-transport decision. Overall, there were 154 of 3330 (4.6%) 9-1-1 recontacts within 72 h. Based on coroner data, three unexpected deaths (0.09%) occurred within 72 h of the initial EMS calls. CONCLUSION: Paramedic disposition by ATR protocols resulted in a low rate of 9-1-1 recontact. Unexpected deaths were extremely rare. Patient satisfaction with the non-transport decision was high.
Subject(s)
COVID-19 , Emergency Medical Services , Adult , Humans , Male , Female , Paramedics , Prospective Studies , PandemicsABSTRACT
OBJECTIVE: Catalina Island's Casino Point is a popular scuba diving site and is located 11.6 nautical miles from the University of Southern California Catalina Hyperbaric Chamber. We sought to determine the best method of providing high-performance CPR during a dive emergency, comparing manual cardiopulmonary resuscitation (CPR) with 2 mechanical compression devices during a simulated boat transport. METHODS: This study was performed on a Los Angeles County Lifeguard rescue boat using 3 manikins and comparing 3 arms: 1) manual compressions with 2 rescuers, 2) mechanical CPR with the Autopulse (ZOLL, Chelmsford, MA), and 3) mechanical CPR with the LUCAS III (Stryker, Kalamazoo, WI). CPR data were collected using ZOLL Stat Padz with an accelerometer connected to ZOLL X Series monitor/defibrillators. The manikins were filmed using mounted cameras. Data were reviewed using ZOLL Case Review. RESULTS: In video footage, all 3 arms appeared to provide high-performance CPR during the 30-minute transport. The compression fractions for manual CPR, the Autopulse, and the LUCAS were 99.57%, 95.51%, and 98.4%, respectively. Engine noise (94.6-101.3 dB) prevented the manual arm from hearing their audio prompts, and motion caused significant artifact on the accelerometers. CONCLUSION: High-performance CPR can successfully be performed on a rescue boat by either manual or mechanical methods. Mechanical CPR offered many logistical advantages.
