Drew E. Dawson

National Emergency Medical Services Information System (NEMSIS)

The absence of emergency medical services (EMS) patient care data has hindered development andevaluation of EMS systems. The National Highway Traffic Safety Administration (NHTSA), in cooperation with the Health Resources andServices Administration (HRSA), has provided funding to the National Association of State EMS Directors to develop a National EMS Information System (NEMSIS). NEMSIS is being designed to provide a uniform national EMS dataset, with standard terms, definitions, andvalues, as well as a national EMS database, with aggregated data from all states on a limited number of data elements. Forty-eight of the states, the District of Columbia, andthree territories signed a memorandum of agreement documenting support for the NEMSIS project andexpressing a desire for full implementation of the NEMSIS dataset. NHTSA has agreed to house the National EMS Database at its National Center for Statistics andAnalysis. NHTSA, in cooperation with HRSA andthe Centers for Disease Control andPrevention, recently entered into a cooperative agreement with the University of Utah School of Medicine to operate a NEMSIS Technical Assistance Center that will provide related assistance to official EMS agencies andto commercial software vendors. The Technical Assistance Center will also biannually assess state andterritorial capabilities to provide data to the national EMS database. NEMSIS will provide a uniform national EMS dataset, with standard terms, definitions, andvalues, as well as a national EMS database, with aggregated data from all states on a limited number of data elements. Many of the potential benefits of implementation of NEMSIS are enumerated in this report.

An Evidence-based Prehospital Guideline for External Hemorrhage Control: American College of Surgeons Committee on Trauma

Abstract This report describes the development of an evidence-based guideline for external hemorrhage control in the prehospital setting. This project included a systematic review of the literature regarding the use of tourniquets and hemostatic agents for management of life-threatening extremity and junctional hemorrhage. Using the GRADE methodology to define the key clinical questions, an expert panel then reviewed the results of the literature review, established the quality of the evidence and made recommendations for EMS care. A clinical care guideline is proposed for adoption by EMS systems. Key words: tourniquet; hemostatic agents; external hemorrhage

A SSESSMENT OF N ATIONALLY R EGISTERED E MERGENCY M EDICAL T ECHNICIAN C ERTIFICATION T RAINING IN THE U NITED S TATES : T HE L EADS P ROJECT

Objectives. To describe the adequacy and characteristics of emergency medical services education as assessed by a population-based sample of emergency medical technician (EMT)-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians. Methods. Stratified random samples of EMT-basics and EMT-paramedics from the National Registry of Emergency Medical Technicians were mailed a 46-item demographic survey and a 16-question education survey in 1999. Results. Overall, EMT-basics and EMT-paramedics reported that course cost and distance to the course were not barriers. The majority of EMT-basic and EMT-paramedic respondents rated their course instructors and course materials as excellent or very good. EMT-basic and EMT-paramedic respondents felt that they were very well prepared from their training in the areas of trauma assessment (63% and 72%), medical assessment (59% and 65%), cardiac arrest management (64% and 76%), and airway management (69% and 77%), respectively. However, EMT-basic and EMT-paramedic respondents were less likely to feel very well prepared regarding childbirth (29% and 44%) and pediatric patient management (36% and 38%). Overall, EMT-paramedics were more likely to report being very well prepared for clinical activities and tasks from their training compared with EMT-basics. Conclusions. These findings suggest that EMT-basics and EMT-paramedics were satisfied and felt well prepared by their certification courses. Opportunities to improve certification training exist, particularly related to childbirth and pediatric patient management.

A National Model for Developing, Implementing, and Evaluating Evidence‐based Guidelines for Prehospital Care

In 2007, the Institute of Medicines (IOMs) Committee on the Future of Emergency Care recommended that a multidisciplinary panel establish a model for developing evidence-based protocols for the treatment of emergency medical systems (EMS) patients. In response, the National EMS Advisory Council (NEMSAC) and the Federal Interagency Committee on EMS (FICEMS) convened a panel of multidisciplinary experts to review current strategies for developing evidence-based guidelines (EBGs) and to propose a model for developing such guidelines for the prehospital milieu. This paper describes the eight-step model endorsed by FICEMS, NEMSAC, and a panel of EMS and evidence-based medicine experts. According to the model, prehospital EBG development would begin with the input of evidence from various external sources. Potential EBG topics would be suggested following a preliminary evidentiary review; those topics with sufficient extant foundational evidence would be selected for development. Next, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology would be used to determine a quality-of-evidence rating and a strength of recommendation related to the patient care guidelines. More specific, contextualized patient care protocols would then be generated and disseminated to the EMS community. After educating EMS professionals using targeted teaching materials, the protocols would be implemented in local EMS systems. Finally, effectiveness and uptake would be measured with integrated quality improvement and outcomes monitoring systems. The constituencies and experts involved in the model development process concluded that the use of such transparent, objective, and scientifically rigorous guidelines could significantly increase the quality of EMS care in the future.

Emergency medical services information systems and a future EMS national database.

Since the early 1970s, various publications and legislation have contributed to the development of emergency medical services (EMS) information systems and databases. Yet, even today, EMS systems vary in their ability to collect patient and systems data and to put these data to use. In addition, no means currently exists to easily link disparate EMS databases to allow analysis at local, state, and national levels. For this reason, the National Association of State EMS Directors is working with its federal partners at the National Highway Traffic Safety Administration (NHTSA) and the Trauma and EMS program of the Health Resources and Services Administrations (HRSAs) Maternal and Child Health Bureau to develop a national EMS database. Such a database would be useful in developing nationwide EMS training curricula, evaluating patient and EMS system outcomes, facilitating research efforts, determining national fee schedules and reimbursement rates, and providing valuable information on other issues related to EMS care.

C OMPENSATION , B ENEFITS , AND S ATISFACTION : T HE L ONGITUDINAL E MERGENCY M EDICAL T ECHNICIAN D EMOGRAPHIC S TUDY (LEADS) P ROJECT

Objective. To determine the compensation, benefit package, and level of satisfaction with the benefits of nationally registered emergency medical technicians (NREMTs) in 2001. Methods. The Longitudinal EMT Attribute Demographic Study (LEADS) Project included an 18-question snapshot survey on compensation with the 2001 core survey. This survey was sent to 4,835 randomly selected NREMTs. A total of 1,718 NREMT-Basics and NREMT-Paramedics, from 1,317 different postal zip codes, responded to the survey. Results. Most NREMTs in the survey (86% of the compensated NREMT-Basics and 85% of the compensated NREMT-Paramedics) were employed primarily as patient care providers. For their emergency medical services (EMS) work in the previous 12 months, compensated NREMT-Basics had mean earnings of

A randomized, prospective, multisite comparison of pediatric prehospital training methods.

18,324 (standard error,

Quality and Accountability: Children’s Emergency Services in a Managed Care Environment

978) and compensated NREMT-Paramedics had mean earnings of

Uniform Prehospital Data Elements and Definitions: A Report From the Uniform Prehospital Emergency Medical Services Data Conference

34,654 (standard error,

Increasing employee awareness of the signs and symptoms of heart attack and the need to use 911 in a State Health Department.

646). At least 26% of compensated NREMT-Basics and 9% of compensated NREMT-Paramedics had no health insurance. The majority of compensated NREMTs (62% of the Basics and 57% of the Paramedics) reported their retirement plans were not adequate to meet their financial needs. EMTs are not satisfied with the appreciation and recognition they receive from EMS employers. About one-third (35% of the compensated NREMT-Basics and 30% of the compensated NREMT-Paramedics) were not satisfied with all of the benefits they receive from their EMS employer. Nearly all (94% of both compensated NREMT-Basics and NREMT-Paramedics) believed that EMTs should be paid more for the job that they do. Conclusions. The adequacy of EMT compensation and benefit packages is an area of concern. It is not unreasonable to believe that these factors are associated with EMT retention and attrition. Additional longitudinal EMT information on compensation and benefits are anticipated to determine the extent to which compensation and benefits are factors in EMT retention.