Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-19T12:00:39.300Z Has data issue: false hasContentIssue false
  • English
  • Français

A Prospective Evaluation of Prehospital Patient Assessment by Direct In-field Observation: Failure of ALS Personnel to Measure Vital Signs

Published online by Cambridge University Press:  28 June 2012

Daniel W. Spaite ,
Elizabeth A. Criss ,
Terence D. Valenzuela ,
Harvey W. Meislin  and
Paul Hinsberg
Daniel W. Spaite*
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Arizona
Elizabeth A. Criss
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Arizona
Terence D. Valenzuela
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Arizona
Harvey W. Meislin
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Arizona
Paul Hinsberg
Affiliation:
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, Arizona
*
Daniel Spaite, MD, Emergency Medicine, University of Arizona, 1501 N. Campbell, Tucson, Arizona 85724, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

We prospectively evaluated the frequency with which advanced life support (ALS) personnel fail to attempt to measure blood pressure (BP) and/or pulse (P) during prehospital patient assessment. A single in-field observer rode on ALS rescue vehicles from 20 Emergency Medical Services (EMS) agencies throughout Arizona during a one-year study (1/89–12/89). Data were collected from urban, suburban, and rural systems. Statistical evaluation was performed by Chi Square analysis with p <0.05 considered significant.

Among 227 patient encounters, BP and/or P measurements were omitted in 84 cases (37.0%). BP and/or P were omitted in 50.0% of children (age <18 years) compared to 26.5% of adults (p=0.023). Among patients who were transported to a hospital, 19.4% had BP omitted compared to 49.1% of those not transported (p=0.00003). Seven of 58 patients in whom TVs were attempted (12.1 %) had BP omitted compared to 54 of 169 patients without IV attempts (32.0%, p=0.0055). Blood Pressure was omitted in 21.9% of patients transported Code 3 and in 24.2% of patients with Glasgow Coma Scale ≤13. Omission of BP occurred more frequently in non-urban agencies (33.9%) than in urban ones (20.0%, p=0.027).

In a statewide evaluation of prehospital patient assessment, failure to measure vital signs (VS) occurred on a frequent basis. Our data indicate that a concerning lack of attention to the most basic details of patient assessment is common. It is possible that failure to measure VS might even happen more frequently during routine patient encounters without an observer present. Medical control physicians must emphasize to EMS personnel the paramount importance of careful assessment to ensure optimal patient care.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 5 , Issue 4 , December 1990 , pp. 325 - 333
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Pepe, PE, Bonnin, MJ, Mattox, KL: Regulating the scope of EMS services. Prehospital and Disaster Medicine 1990;5:59–63.CrossRefGoogle Scholar
2. Spaite, DW, Joseph, M: Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome. Ann Emerg Med 1990;19:279–285.CrossRefGoogle ScholarPubMed
3. Pepe, PE, Copass, MK, Joyce, TH: Prehospital endotracheal intubation: Rationale for training emergency medical personnel. Ann Emerg Med 1985;14:1085–1092.CrossRefGoogle ScholarPubMed
4. Jacobs, LN, Berribeitia, LD, Bennett, B: Endotracheal intubation in the prehospital phase of emergency medical care. JAMA 1983;250:2175–2177.CrossRefGoogle ScholarPubMed
5. Pepe, PE, Stewart, RD, Copass, MK: Prehospital management of trauma: A tale of three cities. Ann Emerg Med 1986;15:1484–1490.CrossRefGoogle ScholarPubMed
6. Smith, JP, Bodai, BI: The urban paramedic's scope of practice. JAMA 1985;253:544–548.CrossRefGoogle ScholarPubMed
7. Copass, MK, Oreskovich, MR, Bladergroen, MR, et al. Prehospital cardiopulmonary resuscitation of the critically injured patient. Am J Surg 1984;148:20–26.CrossRefGoogle ScholarPubMed
8. Former, GS, Oreskovich, MR, Copass, MK, et al. The effects of prehospital trauma care on survival from a 50 meter fall. J Trauma 1983;23:976–981.Google Scholar
9. Pointer, JE: Clinical characteristics of paramedics performance of endotracheal intubation. J Emerg Med 1988;6:505–509.CrossRefGoogle ScholarPubMed
10. Jakobsson, J, Nyquist, O, Rehnqvist, N: Effects of early defibrillauon of out-of-hospital cardiac arrest patients by ambulance personnel. Euro Heart J 1987;8:1189–1194.CrossRefGoogle ScholarPubMed
11. Bachman, JW, McDonald, GS, O'Brien, PC: A study of out-of-hospital cardiac arrests in northeastern Minnesota. JAMA. 1986;256:477–483.CrossRefGoogle ScholarPubMed
12. Pionkowski, RS, Thompson, BM, Gruckow, HW, et al. Resuscitation time in ventricular fibrillation—A prognostic indicator. Ann Emerg Med 1983;12:733–738.CrossRefGoogle ScholarPubMed
13. Eisenberg, MS, Hadas, E, Nuri, I, et al. Sudden cardiac arrest in Israel: Factors associated with successful resuscitation. Am J Emerg Med 1988;6:319–323.CrossRefGoogle ScholarPubMed
14. Eitel, DR, Walton, SL, Guerci, AD, et al. Out-of-hospital cardiac arrest: A six-year experience in a suburban/rural system. Ann Emerg Med 1988;17:808–812.CrossRefGoogle Scholar
15. Stults, KR, Brown, DD, Schug, VL, et al. Pre-hospital defibrillation performed by emergency medical technicians. N Engl J Med 1984;310:219–223.CrossRefGoogle Scholar
16. Eisenberg, MS, Copass, MK, Hallstrom, AP, et al. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med 1989;302:1379–1383.CrossRefGoogle Scholar
17. Weaver, WD, Hill, D, Fahrenbruch, CE, et al. Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med 1988;319:661–666.CrossRefGoogle ScholarPubMed
18. Eisenberg, MS, Hallstrom, AP, Copass, MK, et al. Treatment of ventricular fibrillation: Emergency medical technician defibrillauon and paramedic services. JAMA 1984;251:1723–1726.CrossRefGoogle ScholarPubMed
19. Spaite, DW, Criss, EA, Valenzuela, TD, et al. A new model for providing prehospital medical care in large stadiums. Ann Emerg Med 1988;17:825–828.CrossRefGoogle ScholarPubMed
20. Miller, JD, Sweet, RC, Narayan, R, et al. Early insults to the injured brain. JAMA 1978;240:439–442.CrossRefGoogle Scholar
21. Gildenberg, PL, Makela, M: The effect of early intubation and ventilation on outcome following head trauma. In Dacey, RG, Winn, HR, Rimel, RW et al. (eds),Trauma of the Central Nervous System. New York:Raven Press, 1985, pp 79–90.Google Scholar
22. Pepe, PE, Stewart, RD: Role of the physician in the prehospital setting. Ann Emerg Med 1986;15:1480–1483.CrossRefGoogle ScholarPubMed
23. Pepe, PE: Past, present, and future of emergency medical services. Prehospital and Disaster Medicine 1989;4:47–49.CrossRefGoogle Scholar
24. Copass, MK: The urban experience in medical control. In: Proceedings of the Subcommittee on Medical Control, Committee on Emergency Medical Services, Assembly of Life Sciences National Research Council, National Academy of Sciences. Washington, D.C.:National Academy Press, 1981;92–94.Google Scholar
25. Swor, RA, Krome, RL: Administrative support of emergency medical services medical di-rectors: A profile. Prehospital and Disaster Medicine 1990;5:25–30.CrossRefGoogle Scholar
26. Stewart, RD: Medical direction in emergency medical service. Emerg Med Clin North Am 1986;5:119–132.CrossRefGoogle Scholar
27. Holroyd, BR, Knopp, R, Kallsen, G: Medical control: Quality assurance in prehospital care. JAMA 1986;256:1027–1031.CrossRefGoogle ScholarPubMed
28. McSwain, NE: Medical control of prehospital care (ed). J Trauma 1984;24:172.CrossRefGoogle Scholar
29. Pointer, JE: The emergency physician and medical control in advanced life support. J Emerg Med 1985;3:31–35.CrossRefGoogle ScholarPubMed
30. Cobb, LA, Alvarez, H, Copass, MK: A rapid response system for out-of-hospital cardiac emergencies. Med Clin North Am 1976; 60:283–290.CrossRefGoogle ScholarPubMed
31. Cobb, LA: Prehospital cardiac care: Does it make a difference? Am Heart J 1982;103: 316–318.CrossRefGoogle Scholar
32. Schonfeld, NA, Park, K, Lev, R, et al. Paramedic physical assessment and intervention in children Ann Emerg Med 1989;18:437 (abstract).CrossRefGoogle Scholar
33. Hunt, RC, Allison, EJ, Whidey, TW, et al. Comparison of EMT blood pressure measurements with an automated blood pressure monitor: On scene, during transport, and in the emergency department. Ann Emerg Med 1985;14:871–875.CrossRefGoogle ScholarPubMed
34. Gausche, M, Henderson, DP, Seidel, JS: Vital signs as part of the prehospital assessment of the pediatric patient: A survey of paramedics. Ann Emerg Med 1990;19:173–178.CrossRefGoogle Scholar
35. Selden, BS, Schnitzer, PG, Nolan, FX: Medicolegal documentation of prehospital triage. Ann Emerg Med 1990;19:547–551.CrossRefGoogle ScholarPubMed
36. Spaite, DW, Hanlon, T, Criss, EA et al. ,Prehospital data entry compliance by paramedics after institution of a comprehensive EMS data collection tool. Ann Emerg Med (in press).Google Scholar
37. Pepe, PE, Bolenbaucher, AS, Mattox, KL, et al. The impact of intense physician supervision on the effectiveness of an emergency medical services system. Ann Emerg Med 1988;17:752 (Abstract).Google Scholar
38. Champion, HR, Sacco, WI, Gainer, PS, et al. The effect of medical direction on trauma triage. J Trauma 1988;28:235–239.CrossRefGoogle ScholarPubMed
39. McSwain, NE: Medical control: What is it? JACEP 1978;7:114–116.CrossRefGoogle ScholarPubMed
40. Soler, JM, Montes, MF, Egol, EB, et al. The ten-year malpractice experience of a large urban EMS system. Ann Emerg Med 1985;14:982–985.CrossRefGoogle ScholarPubMed
41. Ayres, JR: The Law and You: Causes of Law-suits: Emergency Medical Update. Winslow, Washington:Ellen Lockert and Assoc, Inc. 1988, Vol 1, p4.Google Scholar
42. Werman, HA, Keseg, DR, Glimpher, M, et al. Retention of basic trauma life support skills. Prehospital and Disaster Medicine 1990;5:137–144.CrossRefGoogle Scholar
43. Ornato, JP, McNeill, SE, Craren, EJ, et al. Limitation on effectiveness of rapid defibrillation by emergency medical technicians in a rural setting. Ann Emerg Med 1984;13:1096–1099.CrossRefGoogle Scholar
44. Donovan, PJ, Cline, DM, Whitley, TW, et al. Prehospital care by EMTs and EMT-Is in a rural setting: Is the advancement justified? Ann Emerg Med 1988;17:415 (Abstract).Google Scholar
45. Smith, N: The incidence of severe trauma in small rural hospitals. J Fam Pract 1987; 25:595–600.Google ScholarPubMed