Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-20T02:36:23.868Z Has data issue: false hasContentIssue false
  • English
  • Français

Opportunities for Emergency Medical Services (EMS) Care of Syncope

Published online by Cambridge University Press:  23 May 2016

Brit J. Long ,
Luis A. Serrano ,
Jose G. Cabanas  and
M. Fernanda Bellolio
Brit J. Long*
Affiliation:
Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, MinnesotaUSA
Luis A. Serrano
Affiliation:
Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, MinnesotaUSA
Jose G. Cabanas
Affiliation:
Austin Travis County Emergency Medical Services, Austin, TexasUSA
M. Fernanda Bellolio
Affiliation:
Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, MinnesotaUSA
*
Correspondence: Brit J. Long, MD 506 Dakota St APT 1 San Antonio, Texas USA E-mail: brit.long@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Emergency Medical Service (EMS) systems are vital in the identification, assessment, and treatment of trauma, stroke, myocardial infarction, and sepsis patients, improving early recognition, resuscitation, and transport. Emergency Medical Service personnel provide similar care for patients with syncope. The role of EMS in the management of patients with syncope has not been reported.

Hypothesis/Objective

The objective of this study was to describe the management of out-of-hospital syncope by prehospital providers in an urban EMS system.

Methods

This was a retrospective cohort study of consecutively enrolled patients over 18 years of age, over a two-year period, who presented by EMS with syncope, or near-syncope, to a tertiary care emergency department (ED). Demographics included comorbidities, history, and physical exam findings documented by prehospital providers, as well as the interventions provided. Data were collected from standardized patient care records for descriptive analysis.

Results

Of the 723 patients presenting with syncope to the ED, 284 (39.3%) were transported by EMS. Compared to non-EMS patients, those who arrived by ambulance were older (mean age 65 [SD = 18.5] years versus 61 [SD = 19.2] years; P = .019). There were no statistically significant differences in cardiovascular comorbidities (hypertension, coronary artery disease, diabetes mellitus, stroke, or congestive heart failure) between EMS and non-EMS patients. The most common chief complaints were fainting (50.0%) and dizziness (44.7%). The most common intervention provided was cardiac monitoring (55.6%), followed by administration of normal saline infusion (50.5%), oxygen (41.9%), blood glucose check (41.5%), and electrocardiogram (EKG; 40.5%).

Conclusion

Emergency Medical Service personnel transport more than one-third of patients presenting to the ED with syncope. Documentation of key elements of the history (witnesses, prodrome, predisposing factors, and post-event symptoms) and physical examination were not recorded consistently.

LongBJ, SerranoLA, CabanasJG, BellolioMF. Opportunities for Emergency Medical Services (EMS) Care of Syncope. Prehosp Disaster Med. 2016;31(4):349–352.

Keywords

cardiovascularEMSsyncope
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 4 , August 2016 , pp. 349 - 352
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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. Huff, JS, Decker, WW, Quinn, JV, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. J Emerg Nurs. 2007;33(6):e1-e17.CrossRefGoogle Scholar
2. Moya, A, Sutton, R, Ammirati, F, et al. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur Heart J. 2009;30(21):2631-2671.Google Scholar
3. Blanc, JJ, L’her, C, Gosselin, G, Cornily, JC, Fatemi, M. Prospective evaluation of an educational program for physicians involved in the management of syncope. Europace. 2005;7(4):400-406.Google Scholar
4. Quinn, J, McDermott, D, Stiell, I, Kohn, M, Wells, G. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006;47(5):448-454.CrossRefGoogle ScholarPubMed
5. Quinn, JV, Stiell, IG, McDermott, DA, Sellers, KL, Kohn, MA, Wells, GA. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med. 2004;43(2):224-232.Google Scholar
6. Schladenhaufen, R, Feilinger, S, Pollack, M, Benenson, R, Kusmiesz, AL. Application of San Francisco Syncope Rule in elderly ED patients. Am J Emerg Med. 2008;26(7):773-778.CrossRefGoogle ScholarPubMed
7. Alshekhlee, A, Shen, WK, Mackall, J, Chelimsky, TC. Incidence and mortality rates of syncope in the United States. Am J Med. 2009;122(2):181-188.Google Scholar
8. Burt, CW, McCaig, LF, Valverde, RH. Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006;47(4):317-326.Google Scholar
9. Wang, HE, Weaver, MD, Shapiro, NI, Yealy, DM. Opportunities for Emergency Medical Services care of sepsis. Resuscitation. 2010;81(2):193-197.Google Scholar
10. Vanek, M. Syncope: a simple faint or a serious situation? Emerg Med Serv. 2002;31(10):110 113-116.Google ScholarPubMed
11. Brunetti, ND, De Gennaro, L, Dellegrottaglie, G, Antonelli, G, Amoruso, D, Di Biase, M. Prevalence of cardiac arrhythmias in pre-hospital tele-cardiology electrocardiograms of emergency medical service patients referred for syncope. J Electrocardiol. 2012;45(6):727-732.Google Scholar
12. Somani, R, Baranchuk, A, Guzman, JC, Morillo, CA. The role of Emergency Medical Services in the assessment and management of syncope. Int J Cardiol. 2012;154(3):368-369.Google Scholar
13. Huff, JS, Decker, WW, Quinn, JV, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49(4):431-444.Google Scholar
14. Figgis, K, Slevin, O, Cunningham, JB. Investigation of paramedics’ compliance with clinical practice guidelines for the management of chest pain. Emerg Med J. 2010;27(2):151-155.Google Scholar
15. Sun, BC, Mangione, CM, Merchant, G, et al. External validation of the San Francisco Syncope Rule. Ann Emerg Med. 2007;49(4):420-427.e4.Google Scholar
16. Blackwell, T, Kellam, JF, Thomason, M. Trauma care systems in the United States. Injury. 2003;34(9):735-739.CrossRefGoogle ScholarPubMed
17. Jollis, J. Moving care forward: prehospital emergency cardiac systems. Circulation. 2010;122(15):1443-1445.Google Scholar
18. Acker, JE 3rd, Pancioli, AM, Crocco, TJ, et al. Implementation strategies for Emergency Medical Services within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association expert panel on Emergency Medical Services systems and the Stroke Council. Stroke. 2007;38(11):3097-3115.CrossRefGoogle Scholar
19. Georgeson, S, Linzer, M, Griffith, JL, Weld, L, Selker, HP. Acute cardiac ischemia in patients with syncope: importance of the initial electrocardiogram. J Gen Intern Med. 1992;7(4):379-386.Google Scholar
20. Martin, TP, Hanusa, BH, Kapoor, WN. Risk stratification of patients with syncope. Ann Emerg Med. 1997;29(4):459-466.CrossRefGoogle ScholarPubMed
21. Sarasin, FP, Pruvot, E, Louis-Simonet, M, et al. Stepwise evaluation of syncope: a prospective population-based controlled study. Int J Cardiol. 2008;127(1):103-111.Google Scholar
22. Colivicchi, F, Ammirati, F, Melina, D, et al. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: The OESIL risk score. Eur Heart J. 2003;24(9):811-819.Google Scholar
23. Reed, MJ, Newby, DE, Coull, AJ, Prescott, RJ, Jacques, KG, Gray, AJ. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol. 2010;55(8):713-721.Google Scholar
24. Quinn, J, McDermott, D. External validation of the San Francisco Syncope Rule. Ann Emerg Med. 2007;50(6):742-743; author reply 743-744.Google Scholar
25. Grossman, SA, Fischer, C, Lipsitz, LA, et al. Predicting adverse outcomes in syncope. J Emerg Med. 2007;33(3):233-239.Google Scholar
26. Sun, BC, Derose, SF, Liang, LJ, et al. Predictors of 30-day serious events in older patients with syncope. Ann Emerg Med. 2009;54(6):769-778.Google Scholar
27. Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, Barta, DC, Steiner, J. Chart reviews in Emergency Medicine research: where are the Methods? Ann Emerg Med. 1996;27(3):305-308.Google Scholar