Assessing EMS scope of practice for utility and risk: the New Mexico EMS Interventions Assessment Project, Phase One results.

INTRODUCTION: Few emergency medical services (EMS) interventions in New Mexico have been assessed for efficacy, potential harm, or potential benefit. There is concern that many interventions added over the years may be outdated, harmful, or ineffective in the EMS setting. A formal process for reviewing the state EMS scope of practice using literature review and expert consensus is discussed. In Phase One of the project, interventions in the New Mexico EMS scope of practice were prioritized for further review by surveying a national cadre of EMS experts to evaluate EMS interventions using a utilitarian harm/benefit metric. METHODS: An electronic survey based on the 2010 New Mexico EMS Scope of Practice statute was administered from March through June, 2011. A national cadre of 104 respondents was identified. Respondents were either State EMS medical directors or EMS fellowship directors. Respondents were asked to rate the potential harm and the potential benefit of specific EMS interventions on a 5-point ordinal scale. Median harm and benefit scores were calculated. RESULTS: A total of 88 completed surveys were received following 208 emailed invitations to 104 respondents (43% response rate). Twenty-two (22) highest-priority interventions (those with a harm/benefit median score ratio of >1) were identified. Seven additional second-priority interventions were also identified. These interventions will be advanced for formal literature review and expert consensus. CONCLUSIONS: The New Mexico EMS Interventions Project offers a novel model for assessing a prehospital scope of practice.

A comparison of intimate partner homicide to intimate partner homicide-suicide: one hundred and twenty-four New Mexico cases.

The authors compare cases of female intimate partner homicide-suicide to female intimate partner homicide alone to describe risk factors and suggest prevention strategies, including strategies in the medical setting. Differences are found between the types of cases in marital relationship, age, blood alcohol, and the use of firearms. Physicians and other health care providers who treat victims of intimate partner violence and patients at risk for suicide should be aware of the interwoven risk factors within these populations. Interventions aimed at suicide prevention as well as targeted removal of firearms should be investigated as tools in the prevention of intimate partner homicide.