patients). Most patients were adult, with only 66 less than 18 years old. 1321 subjects. (64%) received .... Research Forum Abstracts. S42 Annals of Emergency ...
Research Forum Abstracts staffed ambulances in eight rural, semi-urban and urban California counties (cumulative population 3.3 million; 250,000 annual ambulance transports), were treated with ondansetron IV, IM, or ODT. All patients age 4 years or greater who had no known sensitivity to HT3 antagonists were eligible for treatment. An initial dose of 4 mg IV (preferred route), IM, or ODT was used for all patients. Data were collected prospectively for a 6-month period using an online database (Survey Monkey, www.surveymonkey.com). Primary outcome measures were: 1) efficacy as measured by a 10-point visual analog nausea scale, and 2) incidence of adverse effects. There were no control or placebo groups. Confidence intervals for the change in nausea score were calculated and P-values for the changes were calculated using the Wilcoxan signed-rank test. Differences in improvement of nausea scores by route of administration were compared using multiple linear regression. Results: Ondansetron was administered to 2071 patients (3.1% of all transported patients). Most patients were adult, with only 66 less than 18 years old. 1321 subjects (64%) received ondansetron IV, 77 (4%) received ondansetron IM, and 674 (33%) received ODT. IV administration resulted in the largest improvements in nausea scores (mean 4.36, 95%CI [4.15, 4.37]), followed by IM (mean 3.61, 95%CI [2.95, 4.27]) and ODT (mean 3.28, 95%CI [3.06, 3.50]). Overall the mean decrease in nausea score was 3.99 (95%CI [3.82, 4.08], p⬍0.001) on a 10-point scale. After medication administration, four patients had mild hypotension, one had hypertension, two had itching or rash, and one had a brief episode of asymptomatic supraventricular tachycardia that resolved spontaneously. Conclusion: Ondansetron is safe and effective for out-of-hospital treatment of nausea and vomiting when administered by paramedics via the IV, IM and oral route. When available to paramedics, it is used frequently, thus having potential to alleviate suffering for many patients.
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Factors Associated With Ambulance Use for Low Acuity Conditions In an Urban Emergency Department
Pearson C, Kim D, Mango L, Compton S, Levy P/WSU Detroit Receiving Hospital, Detroit, MI; University of Medicine and Dentistry of New Jersey, Newark, NJ
Study Objectives: To identify factors and other health beliefs which may contribute to ambulance use for transportation to the emergency department (ED) by patients with low acuity problems. Methods: This is an observational study of patients 18 years or older who present to the ED of a large, urban, academic medical center with an Emergency Severity Index [ESI] triage level of 4 or 5. Demographic, treatment, disposition, and selfadministered survey (Health Belief Model and Short Test of Functional Health Literacy in Adults [STOFHLA]) data are collected prospectively with grouping of patients by means of arrival (ambulance [AMB] versus private transportation [PT]). Data are presented with group-wise comparison using the t-test for continuous and Fischer’s exact test for categorical variables. Results: A total of 200 patients (100 in each arm) were enrolled. Compared to PT (table), AMB patients were more likely to: be insured (82% versus 56%; p ⫽ 0.0001), lack a regular means of transportation (53% versus 33%; p ⫽ 0.0004), have a primary care provider (62% versus 44%; p⫽ 0.021), perceive that their illness required care within one hour of arrival (38% versus 21%; p ⫽ 0.04), have used an ambulance in the past year (72% versus 21%; p ⫽ 0.001) and would utilize an ambulance in the future for similar concerns (53% versus 15%; p ⫽ 0.0001). AMB patients are more likely to call an ambulance for any health concern (p ⫽ 0.035) and felt that there were enough ambulances for all patients in the city (p ⫽ 0.01). There were no differences in age, % employed, level of income, degree of education, or hospital admission rate (6% versus 3%; p⫽ 0.498) between groups. Conclusion: This study identifies ambulance use in low-acuity ED patients to be influenced by misperceptions regarding severity of illness and resource use, in addition to limited access to private transportation. Understanding patient perceptions of illness and other barriers to receiving care is imperative to modifying behaviors, and this appreciation could enhance the process of linking individuals with the most appropriate provider. An intervention directed toward such perspectives may enable change in the elective use of limited resources and other health behaviors.
S42 Annals of Emergency Medicine
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Improving Cardiopulmonary Resuscitation Training With the Nintendo Wii™
Dommer P, Crismon H, Anand N, Kahol K, Harding S/Maricopa Medical Center, Phoenix, AZ; Arizona State University, Phoenix, AZ
Study Objectives: Quality chest compressions (CCs) are of paramount importance for survival after cardiac arrest. Utilization of commercially available, feedback capable, training devices has been shown to improve the quality of CCs. We sought to use a relatively inexpensive Nintendo Wii™ to improve the quality of CCs given by emergency physicians. Methods: This was a prospective, observational study to examine whether visual feedback using a Nintendo Wii™ could improve CC quality delivered by emergency physicians. 24 physicians from a major urban emergency medicine training program participated. A Wii™ remote was used to detect the dynamic position of an infrared light-emitting diode (LED) strapped to one hand of each participant. Data was transmitted from the Wii™ remote to a computer via Bluetooth™. Each participant performed three one-minute trials of CCs on a standard Laerdal training manikin. Visual feedback was provided only during the second one-minute trial in order to compare CC quality before, during, and after intervention with the Wii™. To minimize bias, the participants were blinded from observing each other while performing CCs. Quality CCs were defined using the 2005 American Heart Association guidelines for rate (100⫾10 CCs/minute) and depth (1.5-2 inches). An additional parameter used to define quality CCs was the allowance of full chest wall recoil after each CC. Statistical t-tests and analysis of variance (ANOVA) were used to detect compliance with CC guidelines and improvements in CC rate, depth, and recoil due to training with the Wii™. Results: Before intervention with the Wii™, mean CC rate 113.17 CC/minute (95% confidence interval (CI) 108.36 to 117.98), mean CC depth 2.15 inches (95% CI 1.98 to 2.32), and mean CCs/minute without full chest recoil 7.50 CCs/minute (95% CI 3.79 to 11.21) were mostly outside recommended guidelines for optimal CCs. While receiving real-time visual feedback with the Wii™, mean CC rate 104.50 CCs/minute (95% CI 99.69 to 109.31), mean CC depth 1.82 inches (95% CI 1.66 to 1.99), and mean CCs/minute without full chest recoil 0.96 CCs/minute (95% CI 0.0 to 4.67) were significantly improved to within recommended guidelines. After subsequently removing visual feed back, mean CC rate 106.46 CCs/minute (95% CI 101.65 to 111.21), mean CC depth 1.80 inches (95% CI 1.63 to 1.97), and mean CCs/minute without full chest recoil 1.33 CCs/minute (95% CI 0.0 to 5.04) remained mostly within defined guidelines. Intervention with the Wii™ caused significant changes in CC rate (P⫽.023), depth (P⫽.017), and allowance of full chest wall recoil (P⫽.041). The effect on CC rate (P⫽.067), depth (P⫽.020), and chest recoil (P⫽.063) was partially maintained even after removal of visual feedback. Conclusion: During simulated CCs, the Nintendo Wii™ successfully improved the quality of CCs provided by emergency physicians to within recommended guidelines. Additional investigation is required to determine optimal length and frequency of training sessions needed to maintain competence in providing high quality CCs.
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Increasing Numbers of Attempts at Endotracheal Intubation Is a Predictor of the Need for Eventual Rescue Airway Placement
Rosenbaum RA, Shiuh T, Megargel R, Nichols W, Reed III J, McGinnis-Hainsworth D/Christiana Care Health Services, Newark, DE; Delaware Office of Emergency Medical Services, Dover, DE
Background: Endotracheal tube placement by EMS personnel remains controversial. Current Delaware (DE) protocol allows each paramedic (ALS) on scene
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