Statement of Purpose: Prehospital death pronouncement policies are common among ground ambulances. No previous report has addressed such policies among Air Medical (AM) programs.

Statement of Methods: Statement of Methods: Structured telephone interviews of 125 of 143 (87%) AM programs (14 fixed wing, 68 rotor wing, 43 both) were conducted by research staff from 6 to 8/95.

Summary of Results: Summary of Results: Only fifty percent of AM crews are permitted to pronounce death in the field. Of those AM programs which permit pronouncement, direct medical command physician contact is required in 35% of pronouncements while 25% of programs utilize protocols. Of those AM programs which permit pronouncement, 77% of flight nurses can pronounce while only 33% of paramedics. Most programs (95%) conduct QA reviews of all deaths.

Statement of Conclusions: Prehospital death pronouncement is permitted in only 50% of AM programs. Since prehospital death pronouncement may obviate the need for AM transport, AM programs may be transporting clinically dead but unpronounced patients wasting scarce medical resources. This differs greatly from ground EMS programs where death protocols are common. Particularly puzzling is the small percentage of flight paramedics who are allowed to pronounce when compared to flight nurses since ground EMS pronouncements are performed by paramedics. AM programs should review their prehospital pronouncement protocols since managed care initiatives will drive health care organizations to abandon the wasteful practice of transporting clinically dead, but unpronounced, patients.

Hypothesis: First responder organizations with automated external defibrillators (AEDs) can have a larger impact on survival of out-of-hospital cardiac arrest than placing AEDs in large buildings.

Methods: To evaluate the impact, all cardiac arrests handled by a large urban fire department for 1994 were analyzed. Each 5.6 square mile area of the city was defined as business (Bus), high (HilRes), middle (MilRes), or low income (LoIRes) residential. For each area, the CPR rates were calculated for the number of arrests/100 ambulance dispatches, and were stratified by percent of adults over age 65.

Results: Of the 1,222 cardiac arrests, only 85 occurred in business and industrial areas, 1,041 occurred in residential areas. The downtown business district had only 77 arrests with half of those being outside of buildings or in shelters.

Purpose: Determination of rapid blood glucose (RGB) by colorimetric stick test aids in the prehospital identification and treatment of hypoglycemia. The test may be applied unnecessarily to patients not at risk for, and in clinical situations not associated with hypoglycemia. We attempted to estimate the rate of over-utilization of RGB in a large urban EMS setting.

Methods: All run sheets during a one week period from 7 sites providing radio command to both city and private EMS units serving a large urban population were screened. Those runs including RGB determination were further classified for presence or absence of a test indication. RGB was considered indicated with history or finding of: altered mental status, decreased level of consciousness, seizure, syncope and near syncope, generalized weakness or dizziness, with or without a history of diabetes.

Results: 613 RGB determinations were identified during one week (annual rate = 31,876). 371 (61%) met indication criteria for test performance, and 242 (39%) failed to meet criteria. The patient complaint in cases not meeting criteria included; cardiac - 80, respiratory distress - 66, trauma - 38, abdominal pain -15, burns - 12, OB - 8, CVA - 6. Moreover, among these patients fewer than half had a history of diabetes. If this rate of over-utilization were maintained for one year, in excess of 12,500 extra tests would be performed in this system.