Session
Emergency Medical Services
APHA 2022 Annual Meeting and Expo
Abstract
Prehospital time differences for patients with illnesses versus motor vehicle accidents in urban, suburban, and rural areas: Findings from a statewide EMS system
APHA 2022 Annual Meeting and Expo
Background: The association between emergency medical services (EMS) prehospital time and patient survival is well-documented. This study aims explores how rurality is associated with prehospital time (response, on-scene, and transport time) for both crash- and health-based EMS events in Alabama.
Methods: We analyzed 2018-2019 911 response calls extracted from Alabama’s EMS database. This resulted in 80,729 crash-based records and 811,133 health-based records. Geographic Information System (GIS) software was used to differentiate the median prehospital time for each county. Quantile regression models were used to assess if the associations between prehospital time and various factors, including county-level rurality, differ along different durations of prehospital time.
Results: Compared to crash-based events, health-based events have longer response and transport times, but shorter on-scene times. Prehospital times are longer (36% - 62%) in rural areas. GIS analysis revealed seven counties clustered near the Alabama-Mississippi border with some of the longest response times. Only one rural county’s (Lowndes) median prehospital time for crash-based events was above 60 minutes, but seven rural counties’ median prehospital time for health-based events were at or above 60 minutes. Lowndes County, which had the longest prehospital times for both crash- and health-based events, is surrounded by counties with some of the fastest prehospital times.
Conclusions: GIS and quantile regression models identified longer prehospital times in rural counties overall and a specific rural region in West Alabama. To improve prehospital time, further investigation is warranted into the EMS resources and hospital services, which influence prehospital time, in these rural areas.
Abstract
Household members of firefighters: Pre-existing risk factors for complications of COVID19 infection
APHA 2022 Annual Meeting and Expo
Background/Purpose: Guidance documents and regulations released during the COVID19 response indicate that emergency responders are at high risk for occupational exposure to the virus and that there is a need for home isolation solutions for firefighters. 1,2 However, there appears to be a knowledge gap in published literature regarding the risk factors among household members of FFs.
Methods: An internet-based survey link was distributed through social media, professional networks, and direct email to firefighters and fire departments located in FL beginning in February 2021. To date, a total of 255 responses has been received. Updated results will be included with the poster presentation.
Results/Outcomes: Of the 255 surveys were submitted to date, the following conditions amongst household members identified for increased risk of severe COVID-19 outcomes* were reported: pregnancy (13%, n=33), obesity (6%,n=15), cancer (5%, n=14), heart conditions (4%,n=11), type II diabetes mellitus (3.5%,n=9), other (4%, n=11). Additional risk factors* were identified for household members, such as: hypertension (49%, n=42), asthma (34%, n=29), other (5%, n=14). Firefighters also reported persons over the age of 65 years (12%, n=31) and under the age of 5 years (31%, n=80) living with them. Among FFs responding, 56% (n=135) reported a belief that they contracted COVID19 as a result of exposure while on duty.
Conclusions: Among the risk factors (and possible risk factors) for more severe illness due to COVID19, the most commonly reported risks for household members of FFs are related to age and pregnancy. The majority of participating FFs have a perception that their COVID19 illness was the result of a job-related exposure. There may be a perceived conflict between work-related risks and protection of household members. Additional information is needed to capture the prevalence of these risk factors, possible transmission from FFs to household members, and COVID19 disease outcomes in household members of FFs. Perceived risks, whether verified or unverified, have the potential to impact FF mental health, burn-out, and work-family conflict during pandemic response.
*as defined by the Centers for Disease Control and Prevention (CDC) at the time of survey creation
1 Occupational Safety and Health Administration (2021). Emergency Temporary Standard: Fact Sheet subpart U – COVID-19 Healthcare ETS. Retrieved from: https://www.osha.gov/coronavirus/ets.
2 Federal Emergency Management Agency (2021). COVID-19 best practice information: Healthcare worker and responder safety. Retrieved from: https://www.fema.gov/sites/default/files/2020-07/fema_covid_bp_healthcare-worker-lodging.pdf
Abstract
A Systematic Literature Review of Hispanics’ Experiences with Emergency Medical Services in the United States Between 2000-2021
APHA 2022 Annual Meeting and Expo
Background: Emergency medical services (EMS) in the United States (U.S.) are activated with a call to 9-1-1, an action that initiates a series of events, including dispatch of emergency personnel and resources, on-scene care, and transportation to an emergency department (ED). EMS serves as an entry point into the U.S. healthcare system, especially for underserved populations, such as Hispanics, who often have challenges accessing preventive and diagnostic care. However, little is known about Hispanics’ experiences with EMS. The objectives of this study are to 1) examine barriers and facilitators to activation of EMS; 2) assess types of on-scene care; 3) identify promoters and detractors of EMS versus non-EMS transport to an ED; and 4) describe changes in Hispanic adults’ experiences with EMS during the COVID-19 pandemic.
Methods: A bibliographic database search was conducted to identify studies on Ovid MEDLINE (PubMed), Web of Science, EMBASE, and CINAHL from January 1, 2000 to December 31, 2021. Study eligibility was assessed using a priori inclusion criteria. Quantitative, qualitative, and mixed-methods studies were included if they discussed Hispanic adults’ experiences with EMS in the U.S. This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Study quality was assessed using the Hawker quality assessment instrument.
Results: We identified 22,394 peer-reviewed articles, 448 were included for full-text review, and 43 met inclusion criteria. Of the 43 studies, 10 examined EMS activation, 10 assessed types of on-scene care, 19 discussed modes of transport to an ED, and 4 described Hispanic adults’ experiences with EMS during the COVID-19 pandemic. The reference group were non-Hispanic whites for all the studies. Of the 10 studies that assessed initial EMS activation, 7 studies reported that Hispanics were less likely to activate EMS. Of the 10 studies that assessed types of on-scene care, 5 studies reported that Hispanics were less likely to have stroke symptoms recognized, pain assessed, pain medication administered, and electrocardiograms conducted. Of the 19 studies that assessed modes of transport to an ED, 12 found that Hispanics were less likely to use an ambulance. The 4 studies that reported experiences with EMS during the COVID-19 pandemic found a decrease in overall EMS calls during the early pandemic period, but a higher proportion of respiratory distress and cardiac arrest among Hispanic adults.
Conclusion: This systematic literature review suggests that Hispanic adults experience health disparities across the different phases of the prehospital care system.
Abstract
Racial differences in 911 calls for overdose emergency among women with history of drug use
APHA 2022 Annual Meeting and Expo
Background/Purpose. Drug overdose deaths are a leading cause of mortality in the United States. Despite the enactment of overdose immunity laws, people who use substances frequently avoid calling 911 for overdose emergency medical services. We examined racial differences in 911 overdose-related calls among women with history of illicit substance use.
Methods. During 2016-2017, 195 women with lifetime illicit substance use and experience of witnessing an overdose were recruited at harm reduction service points in Philadelphia. Participants took a survey examining their sociodemographic characteristics and overdose history. Logistic regression estimated the odds of making a call to emergency services at the last witnessed overdose between White women and Women of Color.
Results/Outcomes. The sample was 65.1% White and 34.9% Women of Color, including 19.0% African-Americans, 8.2% Hispanics, 5.6% multiracial, and 2% Pacific Islander/Native Americans. Women of Color and White women had identical medians of personal (2) and witnessed (5) overdoses and were not statistically different on lifetime overdose prevention training (55.9% Women of Color vs. 56.7% White), lifetime arrest (83.8% Women of Color vs. 83.5 % White), and the administration of naloxone, an opioid antidote, during the last witnessed overdose (11.8% Women of Color vs. 17.3% White). However, a significantly smaller proportion of Women of Color (35.3%) than White women (54.3%) made a 911 call at the most recently witnessed overdose (p=.011). Differences remained significant (adjusted odds ratio:0.407, 95%CI:0.217-0.762) even after controlling the model for overdose training, arrest, naloxone use, and frequency of personal and witnessed overdoses.
Conclusions: Exposure to racialized policing and concerns about substance use or being on probation may interfere with the willingness of people of color to report overdoses to emergency health services. Measures to address racial bias in police encounters and increase trust between law enforcement and communities of color may help alleviate persistent health disparities. Additionally, addressing differential treatment in policing may increase the frequency of overdose-related 911 calls by persons of color who witness overdoses.
Abstract
Concussion Recovery in Youth Optimized using a Comprehensive App-based Program (CRYO CAP)
APHA 2022 Annual Meeting and Expo
Background: Substantial research suggests that therapeutic hypothermia could ameliorate the devastating impact of Traumatic Brain Injury (TBI). The project’s goals were: 1) To study the effects of concussion in a validated animal model (Drosophila melanogaster) and determine whether therapeutic hypothermia could mitigate neurocognitive impacts and 2) To engineer a device (CRYO CAP) that delivers consistent cerebral hypothermia to an athlete who has suffered mild TBI, using app-based technology to diagnose the concussion and monitor recovery. Methods: Fly experiment - A “high-impact trauma (HIT) device was used to induce mechanical damage to the brain of subjects. Flies were separated into a control group and a hypothermia group, which was cooled for 3 minutes in a refrigerator at a temperature of 160 C. CRYO CAP has 3 main components: an electrical system, a cooling system, and a helmet. The electrical system includes a 12-volt, 35-amp-hour battery and a 12-volt, 7-amp-hour battery that power the cooling system and app interface. The cooling system utilizes 5 thermoelectric coolers, 2 liquid pumps, and 3 aluminum cooling blocks to form 2 liquid cooling circuits. A single and dual radiator design were tested to compare cooling performance. The helmet is lined with cooling tubing and uses a temperature sensor, at the athlete’s temple, which connects to an Arduino microcontroller to relay temperature data to the app. The app diagnoses and classifies the TBI using the Glasgow Coma Scale. Mild TBI prompts cooling for 30 minutes. The app then prompts the user to complete the Concussion Symptom Scale (CSS), a validated symptom inventory, which is assessed daily for 14 days. Results: In flies, average time to sedate for control vs. concussion vs. concussed hypothermia was 77.8, 52.4, and 65.4 seconds, respectively (P < .0001). The single and dual radiator designs resulted in temperatures of 11.2°C (10.8°C temperature reduction) and of 8.5°C (11.9°C temperature reduction), respectively. Conclusion: Concussed flies demonstrated much less time to sedate compared with controls, and hypothermia seemed to mitigate this negative effect. CRYO CAP provides therapeutic hypothermia after a concussive head injury, empowers users with technical support, and collects data in real-time that innovatively connects the trainer and athlete at the bench to the physician at the bedside.
Abstract
Death Certification Trainings to Improve the Quality of Disaster-Related Mortality Data
APHA 2022 Annual Meeting and Expo
Background
Three consecutive and powerful hurricanes made landfall in the southeastern continental United States and the Caribbean including U.S. territories, Puerto Rico and U.S. Virgin Islands (USVI), in August and September 2017, causing massive devastation and numerous deaths. Obtaining an accurate count of disaster-related deaths is typically challenging but is important for disaster response, recovery, and preparedness. In 2018, the Centers for Disease Control and Prevention (CDC) received supplemental funds to improve the accuracy of death counts in the affected jurisdictions. In 2019, CDC expanded the project to additional states to improve mortality surveillance in local and state health departments. The project aims to improve the quality of mortality data by equipping death certifiers with the knowledge to accurately record and report deaths, especially disaster-related deaths.
Methods
CDC’s National Center for Environmental Health and National Center for Health Statistics partnered with public health agencies, state and territory health departments, and nonprofit organizations to develop and implement death certification trainings including disaster-related deaths in selected U.S. states and territories. Puerto Rico, the U.S. Virgin Islands, and Texas were initially selected while Pennsylvania, Tennessee, and Ohio were included a year later. To inform training course agendas, an assessment was performed to determine the current death certifier workforce and evaluate their knowledge of the death certification process. Each jurisdiction established a training goal based on assessment findings. CDC conducted initial training-of-trainers (ToT) sessions. Subsequent trainings were conducted by trained trainers in each jurisdiction.
Results
Between March 2019 to June 30, 2021, CDC and project partners conducted 349 (52 in-person and 297 virtual) trainings and trained a total of 2,257 persons, of which 72% (1,625) were death certifiers. Of the trained death certifiers, 40% (656) were from Texas, 21% (337) from Puerto Rico, 14% (227) from Tennessee, 14% (226) from Ohio, 9% (151) from Pennsylvania, and 2% (28) from USVI. Furthermore, Puerto Rico established the death certification training course in medical schools to prepare future death certifiers while most partner jurisdictions prepared on-demand videos to sustain trainings efforts and continue to improve the quality of mortality data.
Conclusion
CDC and public health partners in the United States and U.S. territories implemented death certification training courses aimed at progressively improving the quality of mortality data. This may help to improve public health surveillance and inform disaster preparedness, response, and recovery efforts.
Abstract
Enhancing the Accuracy of Reporting Disaster-Related Mortality Data During Disaster Response
APHA 2022 Annual Meeting and Expo
Background
Disaster-related mortality data are important to measure the severity of a disaster and identify hazards that lead to death. Accurate and timely death data is needed for jurisdictions to support public health decision-making. Several Centers for Disease Control and Prevention (CDC) mortality surveillance evaluations conducted after disasters identified underreporting of disaster-related deaths as a significant problem. Underreporting was caused partly by the lack of, or limited description of, the circumstance of death and the failure to mention the disaster event on the death certificates. This leads to challenges in reporting the official number of disaster-related deaths. To address these challenges, in 2017, CDC developed tools and trainings to improve investigating disaster deaths and documenting disaster circumstances on the death certificate. To evaluate these efforts, CDC launched a three-year project aiming to enhance current processes for identifying and reporting disaster-related deaths through practice-based research and evaluation; data-driven recommendations; and resource development, translation, and dissemination.
Methods
This project is a collaboration between three CDC centers (the Center for Preparedness and Response, the National Center for Environmental Health, and the National Center for Health Statistics) and NORC at the University of Chicago. This project evaluates existing practices, challenges, CDC training resources, identifies best practices, and develops evidence-based resources and translation materials for multiple audiences involved in reporting disaster-related deaths. The research methods include peer-reviewed and grey literature searches, an online survey with death certifiers, focus groups, and interviews with key informants from state and local public health agencies.
Results
The intended outcome of this project is an evaluation of the knowledge and use of CDC’s disaster-related death certification training and the death scene investigation toolkit. The expected product is a suite of disaster-mortality reporting resources, including four to six reference tools/materials, two resource guides, and three online trainings for tracking and certifying disaster-related mortality among death certifiers and state, tribal, local, and territorial (STLT) public health agencies. The resource guides and training materials on disaster-related death certification (in progress) will be available on the CDC Disaster Epidemiology and Response website with continuing education credits.
Conclusion
To enhance the disaster-related mortality reporting process, it is important to assess current knowledge and practice of death certifiers and develop resources and training materials to support STLT agencies. The enhanced products and tools developed for this project will be available for stakeholders to support public health decision-making during disaster response.
Abstract
America is Bleeding Dry
APHA 2022 Annual Meeting and Expo
Background: Blood Products are some of the most important medical necessities and the United States is no stranger to shortages. In fact, at almost no point in recent history have blood banks been adequately stocked. In recent times, in light of a global pandemic, we have seen a significant decline in donations while the need for blood products has increased. This has led to the worst shortage in over a decade according to the American Red Cross.
Proposed Intervention: A blood drive hosted by community hospital and local residency program with the intent of providing resources for the local community and allowing medical staff/community to give back through another channel.
Methods: Required communication taking place between Residency program and Hospital administration with proposed date and time emphasizing the benefit. Contact and planning with local blood donation center Community Blood Center. Mobilization after approval including a multi-faceted approach to recruitment. Recruiting through email, posters hanging throughout hospitals and clinics as well as direct communication with residency program during didactic sessions. Electronic/Online sign up for specific times on designated day local hospital conference center.
Results: Successful blood drive held at local community hospital sponsored by resident physician leading to direct benefit to local blood center and emergency relief supply as well as support gained by hospital administration leading to an additional blood drive that has already been scheduled.
Next Steps: Demonstrating not only the direct medical and community benefit but the possibility of reproducing this event routinely; Efforts are now being made that would allow expansion to the entire network of Kettering Hospitals thus increasing blood donations 10 fold.
Conclusion: The need for blood and blood products is an ongoing challenge that requires active involvement and willingness to participate by each community and its members. By facilitating an opportunity to give back by donating blood eliminates financial obligations and significant amounts of time for health and community members. Hospitals with residency programs are a great way to facilitate an opportunity and spearhead a movement of blood donation.