Trends in utilization of Emergency Medical Services (EMS) systems can be used to extrapolate future use of an EMS system, which will be valuable for the budgeting and planning of finances and resources. The best model for incorporation of seasonal and regional fluctuations in utilization to predict future utilization is unknown.

Authors aimed to trend patterns of utilization in a regional EMS system to identify the needs of a growing population and to allow for a better understanding of how the EMS system is used on a basis of call volume and frequency of EMS transportation. The authors then used a best-fitting prediction model approach to show how the studied EMS system will be used in future years.

Systems data were retrospectively extracted by using the electronic medical records of the studied EMS system and its computer-assisted dispatch (CAD) database from 2010 through 2017. All EMS dispatches entering the system’s 9-1-1 public service access point were captured. Annual utilization data were available from 2010 through 2017, while quarterly data were available only from 2013 through 2017. The 9-1-1 utilization per capita, Advanced Life Support (ALS) utilization per capita, and ALS cancel rates were calculated and trended over the study period. The methods of prediction were assessed through a best-fitting model approach, which statistically suggested that Additive Winter’s approach (SAS) was the best fit to determine future utilization and ALS cancel rates.

Total 9-1-1 call volume per capita increased by 32.46% between 2010 and 2017, with an average quarterly increase of 0.78% between 2013 and 2017. Total ALS call volume per capita increased by 1.93% between 2010 and 2017. Percent ALS cancellations (cancelled en route to scene) increased by eight percent between 2010 and 2017, with an average quarterly increase of 0.42% (2013–2017). Predictions to end of 2019 using Additive Winter’s approach demonstrated increasing trends in 9-1-1 call volume per capita (R2 = 0.47), increasing trends of ALS utilization per capita (R2 = 0.71), and increasing percent ALS cancellation (R2 = 0.93). Each prediction showed increasing future trends with a 95% confidence interval.

The authors demonstrate paramount per capita increases of 9-1-1 call volume in the studied ALS system. There are concomitant increases of ALS cancellations prior to arrival, which suggests a potential burden on this regional ALS response system.

The aim of this study was to examine the various modern music genres and their effect on the utilization of medical resources with analysis and adjustment for potential confounders.

A retrospective review of patient logs from an open-air, contemporary amphitheater over a period of 10 years was performed. Variables recorded by the medical personnel for each concert included the attendance, description of the weather, and a patient log in which nature and outcome were recorded. The primary outcomes were associations of genres with the medical usage rate (MUR). Secondary outcomes investigated were the association of confounders and the influences on the level of care provided, the transport rate, and the nature of medical complaint.

A total of 2,399,864 concert attendees, of which 4,546 patients presented to venue Emergency Medical Services (EMS) during 403 concerts with an average of 11.4 patients (annual range 7.1-17.4) each concert. Of potential confounders, only the heat index ≥90°F (32.2°C) and whether the event was a festival were significant (P=.027 and .001, respectively). After adjustment, the genres with significantly increased MUR in decreasing order were: alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music (P<.05). Medical complaints were significantly increased with alternative rock or when the heat index was ≥90°F (32.2°C; P<.001). Traumatic injuries were most significantly increased with alternative rock (P<.001). Alcohol or drug intoxication was significantly more common in hip-hop/rap (P<.001). Transport rates were highest with alcohol/drug intoxicated patients (P<.001), lowest with traumatic injuries (P=.004), and negatively affected by heat index ≥90°F (32.2°C; P=.008), alternative rock (P=.017), and country music (P=.033).

Alternative rock, hip-hop/rap, modern rock, heavy metal/hard rock, and country music concerts had higher levels of medical resource utilization. High heat indices and music festivals also increase the MUR. This information can assist event planners with preparation and resource utilization. Future research should focus on prospective validation of the regression equation.

Westrol MS, KoneruS, McIntyreN, Caruso AT, ArshadFH, MerlinMA. Music Genre as a Predictor of Resource Utilization at Outdoor Music Concerts. Prehosp Disaster Med. 2017;32(3):289–296.

The most effective dose of prehospital furosemide in acute decompensated heart failure (ADHF) has not yet been identified and concerns of worsening renal function have limited its use.

To assess if administering high-dose furosemide is associated with worsening renal function.

The authors conducted a 2-center chart review for patients who presented via a single Emergency Medical Service (EMS) from June 5, 2009 through May 17, 2013. Inclusion criteria were shortness of breath, primarily coded as ADHF, and the administration of furosemide prior to emergency department (ED) arrival. A total of 331 charts were identified. The primary endpoint was an increase in creatinine (Cr) of more than 0.3 mg/dL from admission to any time during hospital stay. Exploratory endpoints included survival, length-of-stay (LOS), disposition, urine output in the ED, change in BUN/Cr from admission to discharge, and change in Cr from admission to 72 hours and discharge.

When treated as a binary variable, there was no association observed between an increase in Cr of more than 0.3 mg/dL and prehospital furosemide dose. Baseline characteristics found to be associated with dose were included in the logistic regression model. Lowering the dose of prehospital furosemide was associated with higher odds of attaining a 0.3 mg/dL increase in Cr (adjusted OR = 1.49 for a 20 mg decrease; P = .019). There was no association found with any of the exploratory endpoints.

Patients who received higher doses of furosemide prehospitally were less likely to have an increase of greater than 0.3 mg/dL in Cr during the hospital course.

NievesLC, MehrtensGM, PoresN, PickrellC, TanisJ, SattyT, ChuangM, YoungTC, MerlinMA. The Effect of Furosemide Dose Administered in the Out-of-hospital Setting on Renal Function Among Patients with Suspected Acute Decompensated Heart Failure. Prehosp Disaster Med. 2015;30(1):1-8.

Tissue transplantation is an important adjunct to modern medical care and is used daily to save or improve patient lives. Tissue allografts include bone, tendon, corneas, heart valves and others. Increasing utilization may lead to tissue shortages, and tissue procurement organizations continue to explore ways to expand the cadaveric donor pool. Currently more than half of all deaths occur outside the acute care setting.

Many who suffer prehospital deaths might be eligible for non-organ tissue donation.

A retrospective review of electronic prehospital medical records was conducted from May 1, 2008 through December 31, 2009. All prehospital deaths were included irrespective of cause. Once identified, additional medical history was obtained from prehospital, inpatient, and emergency department records. Age, medical history, and time of death were compared to exclusion criteria for four tissue procurement organizations (MTF, LifeNet, LifeCell, EyeBank). After analysis, percentages of eligible donors were calculated.

Over 50,000 prehospital records were reviewed; 432 subjects died in the field and were eligible for analysis. Ages ranged from four to 103 years of age; the average was 68.3 (SD = 20.1) years. After exclusion for age, medical conditions, and time of death, 185 unique patients (42.8%) were eligible for donation to at least one of the four tissue procurement organizations (range 11.6%-34.3%).

After prehospital death, many individuals may be eligible for tissue donation. These findings suggest that future prospective studies exploring tissue donation after prehospital death are indicated. These studies should aim to clarify eligibility criteria, create protocols and infrastructure, and explore the ethical implications of expanding tissue donation to include this population.

ShiroffAM, GaleSC, MerlinMA, CrystalJS, LingerM, ShahAD, BeaumontE, LustigerE, TabakinE, GraciasVH. Enhancing the Tissue Donor Pool through Donation after Death in the Field. Prehosp Disaster Med. 2013;28(2):1-4.

Predicting injury patterns of patients based only on mechanism of injury is difficult and is well described in the literature. Characteristics of patients on-scene immediately following injury(ies) may lead to predicting injury patterns. Although reported frequently, the significance of victim ambulation after a motor vehicle crash is poorly understood. It was hypothesized that ambulation at the scene is not predictive of injury severity following a motor vehicle crash (MVC).

A prospective, cohort study of 117 consecutive injured patients who were ambulatory after MVCs were enrolled. Paramedics in a large urban Emergency Medical Services (EMS) system were mandated to document “ambulatory” or “nonambulatory” for motor vehicle collisions in order to complete their prehospital electronic medical records. This assured accuracy and completeness in the data collection. All charts were abstracted for trauma-induced injury and imaging results.

A total of 608 (10.9%) persons were ambulatory at the scene, of which 284 had an injury pattern documented in the prehospital or emergency department record. The average age was 35.9 (SD = 16.8) years, and 158 (55.6%) were male. A total of 707 injuries were identified in the 284 patients who had sustained injuries.

Ambulation after motor vehicle collisions appears to be only infrequently associated with major injuries, although this population still may present with significant injuries. A larger, prospective study is warranted.

MerlinMA, CiccosantiC, SayboltMD, BockoffO, MazzeiM, ShiroffA. A Prospective Observational Analysis of Ambulation After Motor Vehicle Collisions. Prehosp Disaster Med. 2013;28(1):1-3.

The objective of this study was to evaluate the time saved by usage of lights and siren (L&S) during emergency medical transport and measure the total number of time-critical hospital interventions gained by this time difference.

A retrospective study was performed of all advanced life support (ALS) transports using lights and siren to this university emergency department during a three-week period. Consecutive times were measured for 112 transports and compared with measured transport times for a personal vehicle traveling the same day of the week and time of day without lights and siren. The time-critical hospital interventions are defined as procedures or treatments that could not be performed in the prehospital setting requiring a physician. The project assessed whether the patients received the hospital interventions within the average time saved using lights and siren transport.

The average difference in time with versus without L&S was -2.62 minutes (95% CI: -2.60− -2.63, paired t-test p <0.0001). The average transport time with L&S was 14.5 ±7.9 minutes (min) (1 standard deviation/minute (min), range = 1–36 min.). The average transport time without L&S was 17.1 ±8.3 min (range = 1−40 min). Of the 112 charts evaluated, five patients (4.5%) received time-critical hospital interventions. No patients received time-critical interventions within the time saved by utilizing lights and siren. Longer distances did not result in time saved with lights and siren.

Limiting lights and siren use to the patients requiring hospital interventions will decrease the risks of injury and death, while adding the benefit of time saved in these critical patients.

A rapid sequence intubation (RSI) method was introduced to a university-based emergency medical services (EMS) system. This is a report of the initial experience with the first 50 patients in a unique, two-tiered, two-advanced life support (ALS) providers system.

The data were evaluated prospectively after an extensive RSI training period, consisting of didactic information and skills performance. Fifty consecutive patient records that documented the procedure were abstracted. Data abstracted included end-tidal CO2, heart rate, blood pressure, and pulse oximetry at various time intervals. Intubation success rates and number of attempts were documented. The consistency of proper documentation also was noted on patient care records.

No differences were noted in heart rate prior to RSI and one and five minutes after the RSI procedure was begun. No differences in blood pressure at one and five minutes were noted. Statistically significant improvements were found in pulse oximetry comparing prior to RSI and one minute after (p < 0.001; 95% CI = 3.15–11.41) as well as prior to RSI and five minutes after RSI was started (p < 0.0002; 95% CI = 4.60–13.33). No differences were observed in end-tidal CO2 at one and five minutes. Overall intubation success rate was 96%, with 82% on first attempt and 92% on two or less attempts. Documentation for individual vitals was consistently <75%.

Patients had no significant worsening of vital signs during the RSI procedure and mild improvement in pulse oximetry. Intubation success rates were consistent with national averages. Proper documentation was lacking in more than one quarter of the charts. These data add to a body of literature that raises further concerns regarding prehospital RSI.