Updated February 2015
A study in the Oct. 2, 2013, issue of JAMA reports that about 11% of people who suffered sudden cardiac arrest in Denmark in 2010 survived at least 30 days, up from 3% in 2005. Researchers from Copenhagen University Hospital Gentofte attribute the tripling of survival to a national effort to boost bystander CPR and other CPR-related initiatives.
About a decade ago, Denmark began implementing several national CPR initiatives, including introducing CPR training in elementary schools, requiring teens to learn CPR in order to get a driver’s license, distributing 150,000 CPR training kits, increasing the availability of AEDs in public places and increasing the use of dispatcher-assisted CPR. Between 2008 and 2010, an estimated 15% of the Danish population was trained in CPR.
To see if those efforts were having an effect, researchers analyzed data from nearly 19,500 people who experienced out-of-hospital cardiac arrest between June 2001 and December 2010. Over that period, bystander CPR more than doubled, from 22% in 2001 to 45% in 2010. The percentage of cardiac arrest victims who arrived at a hospital alive also increased from 8% to 22%, while the percentage of patients alive after one year also more than tripled, from 3% in 2001 to 10% in 2010.
Many patients transported to trauma center could be treated elsewhere
During a three-year period, EMS in seven metropolitan areas in the western United States transported 85,000 injured patients to major trauma hospitals who didn’t need to go there, finds a study by researchers at Oregon Health & Science University (OHSU) reported in the October 2013 issue of Health Affairs.
According to the study, “Regionalized trauma care has been widely implemented in the United States, with field triage by EMS playing an important role in identifying seriously injured patients for transport to major trauma centers.” Yet those guidelines aren’t always followed.
Researchers analyzed data from 94 EMS agencies in Portland/Vancouver; Sacramento; Santa Clara, Calif.; Salt Lake City; King County (Seattle); San Francisco; and Denver County from January 2006 through December 2008. During that time, 248,342 injured patients were considered “low-risk,” meaning they didn’t meet field triage guidelines for transport to trauma centers. Yet 34.3% of them (85,155) were taken to major trauma centers anyway. With average per-episode cost of care nearly $5,600 higher in a Level 1 trauma center than a non-trauma hospital, adhering to the guidelines could save an estimated $137 million annually. Even when restricted to patients with minor injuries, the average per-patient cost at Level I trauma centers was $4,833 higher than non-trauma hospitals.
“What our study shows is there are huge cost implications in how EMS systems work to get injured patients to the appropriate hospitals,” said the study’s lead author, Craig Newgard, M.D., an associate professor of emergency medicine at OHSU, in a university news release. “And it shows how very early decisions in the process of health care—even prior to a patient arriving at the hospital—can lead to much higher costs downstream for our health care system.”
The study did not examine the reasons patients who didn’t meet the criteria were taken to major trauma centers, but follow-up research suggests that patient requests and hospital proximity figure into EMS decision-making, according to the news release.
Danish study shows EMS providers can safely give nasal fentanyl
Intranasal fentanyl administered by EMS providers is both safe and effective at reducing pain, according to a study published Nov. 25, 2013, in the Annals of Emergency Medicine.
The study, by researchers at Copenhagen University Hospital in Denmark and colleagues, included 903 patients aged 8 and older experiencing severe pain from orthopedic injuries, abdominal pain or chest pain that didn’t respond to nitroglycerin spray. About 79% of patients treated with intranasal fentanyl prior to hospital arrival described clinical relevant pain reduction scores of two or greater.
On a scale of one to 10, median initial pain score was eight, while the median pain reduction score after administration was three. Only about 4% experienced adverse events such as mild hypotension, nausea, vomiting, decreased consciousness, vertigo, fatigue, worsening abdominal pain and rash, though none were serious.
A physician had to approve the intranasal opioid prior to EMS giving it. Patients, who were given one to three doses of either 50 or 100 mcg, had a Glasgow Coma Scale score of 15 or greater and a respiration frequency of 10 breaths/minute or greater, and did not have nasal trauma or known opioid intolerance. Mean decrease in respiratory rate was 1.2 breaths/minute.
In the United States, intranasal fentanyl is a schedule II (high potential for abuse) prescription drug marketed under the brand name Lazanda. It was approved in 2011 for cancer pain.
FDA OK’s use of expired auto-injectors
EMS should continue to use some recently expired auto-injectors made by Meridian Medical Technologies if no other product is available due to a disruption in supply, according to a Nov. 22, 2013, statement from the FDA. Evidence shows that atropine/pralidoxime chloride (DuoDote) auto-injectors can be used for a year beyond the expiration date, according to the statement.
EMS should retain other auto-injectors, including atropine (Atropen), morphine sulfate, pralidoxime chloride and diazepam, that are nearing or beyond their labeled expiration dates while the FDA reviews whether these drugs can be used beyond their expiration. Read the statement at tinyurl.com/m9k7v6l.
