appearances on ambulances: do emergency medical ...€¦ · from march 2015 to september 2015...

Objective § To specifically determine whether the attire, number, and gender of EMTS affect patients during prehospital medical emergencies Methods Acknowledgement: This study was supported by the Rutgers Aresty Undergraduate Research Fellowship, the Bigel Endowment in Anthropology, and the Jamesburg First Aid Squad. Background \\ § Prehospital medical care is known to vary among and within emergency medical service (EMS) agencies § Emergency medical technicians (EMTs) responding to emergency calls can differ in their individual attributes § It is unknown whether characteristics of EMTs differentially influence prehospital patient care Results 1 Palliative and Advanced Illness Research (PAIR) Center, 2 Leonard Davis Institute (LDI) of Health Economics, University of Pennsylvania; 3 Rowan University School of Osteopathic Medicine; 4 New Jersey State Department of Health; 5 Jamaica Hospital Medical Center; 6 Department of Anthropology, Rutgers University; 7 Center for Bioethics and Social Sciences in Medicine (CBSSM), University of Michigan; 8 Department of Social and Decision Sciences, Carnegie Mellon University Kuldeep N. Yadav 1,2 , Christina A. Spoleti 3 , Keith R. Anacker 3 , Robert J. Eng 4 , Kinjal G. Solanki 5 , Susan Cachel 6 , Jeffrey DeWitt 7 , Gretchen B. Chapman 8 § We conducted the study at a local volunteer first-aid squad from March 2015 to September 2015 § EMTs’ attire (e.g., professional or casual) alternated weekly, but number and gender varied by the squad’s shift schedule § Emergency medical calls were included only if patients were 18+ years old, alert and oriented x3, not given advanced life support (ALS), not approached by police or fire personnel, and transported to a hospital § We dichotomized the quantity into =2 or >2 EMTs and the gender of the EMT primarily ßproviding patient care into discordant or concordant relative to the gender of patients. § We examined associations between EMTs’ attributes and patients’ vitals before and after transport through regression models § 48 emergency calls were included in final analyses § EMTs’ attributes were evenly distributed among all included emergency medical calls § attire: professional (n=23), casual (n=25) § number: =2 EMT (n=24), or >2 EMTs (n=24) § gender (EMT-Pt): concordant (n=26), discordant (n=22) Figure 1. Variation in patients’ vitals by attributes of emergency medical technicians § When the EMT’s gender was concordant to that of patients, patients exhibited a significantly higher systolic blood pressure reading before transport (p<0.05), but not after transport (p>0.05, Figure 1C) Appearances on Ambulances: Do Emergency Medical Technicians' Attire and Gender Affect Patients' Vitals during Prehospital Medical Emergencies? Social and Decision Sciences § 48 emergency calls were included in final analyses § Medical situations included general pain (31%), cardiac issues (19%), respiratory issues (15%), psychological evaluations (8%), and others (27%) § Patients had an average age of 50 years (range=20-85 years), and 56% were female § Patients’ mean heart rate was 98.1 bpm before transport and 92.6 bpm after transport § Patients’ mean blood pressure (systolic/diastolic) was 144.7/88.1 mmHg before transport and 140.7/87.4 mmHg after transport § No relationships between the attire or number of EMTs and patients’ vitals were identified (Figure 1) Conclusions § When patients are most vulnerable, EMTs’ gender may elevate patients’ systolic blood pressure, increasing their risks of cardiovascular events (e.g., stroke, heart attack) § Our exploratory findings warrant future corroboration in a larger, representative sample § Only then can we explore ways to reduce any undue influence of EMTs’ attributes on prehospital patient care Limitations § A study within a single small-town first-aid squad may not be generalizable to larger, regional EMS agencies § We excluded several emergency scenarios: § patients who did not require or actively refused medical transport to the hospital § patients in emergency situations that had required police, fire, or ALS

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Page 1: Appearances on Ambulances: Do Emergency Medical ...€¦ · from March 2015 to September 2015 §EMTs’ attire (e.g., professional or casual) alternated weekly, but number and gender

Objective§ Tospecificallydeterminewhethertheattire,number,and

genderofEMTSaffectpatientsduringprehospitalmedicalemergencies

Methods

Acknowledgement: This study was supported by the Rutgers Aresty Undergraduate Research Fellowship, the Bigel Endowment in Anthropology, and the Jamesburg First Aid Squad.

Background\\

§ Prehospitalmedicalcareisknowntovaryamongandwithinemergencymedicalservice(EMS)agencies

§ Emergencymedicaltechnicians(EMTs)respondingtoemergencycallscandifferintheirindividualattributes

§ ItisunknownwhethercharacteristicsofEMTsdifferentiallyinfluenceprehospitalpatientcare

Results

1Palliative and Advanced Illness Research (PAIR) Center, 2Leonard Davis Institute (LDI) of Health Economics, University of Pennsylvania; 3Rowan University School of Osteopathic Medicine; 4New Jersey State Department of Health; 5Jamaica Hospital Medical Center; 6Department of Anthropology, Rutgers University; 7Center for Bioethics and Social Sciences in Medicine (CBSSM), University of Michigan; 8Department of Social and Decision Sciences, Carnegie Mellon University

Kuldeep N. Yadav1,2, Christina A. Spoleti3, Keith R. Anacker3, Robert J. Eng4, Kinjal G. Solanki5, Susan Cachel6, Jeffrey DeWitt7, Gretchen B. Chapman8

§ Weconductedthestudyatalocalvolunteerfirst-aidsquadfromMarch2015toSeptember2015

§ EMTs’attire(e.g.,professionalorcasual)alternatedweekly,butnumberandgendervariedbythesquad’sshiftschedule

§ Emergencymedicalcallswereincludedonlyifpatientswere18+yearsold,alertandorientedx3,notgivenadvancedlifesupport(ALS),notapproachedbypoliceorfirepersonnel,andtransportedtoahospital

§ Wedichotomizedthequantityinto=2or>2EMTsandthegenderoftheEMTprimarilyßproviding patientcareintodiscordantorconcordantrelativetothegenderofpatients.

§ WeexaminedassociationsbetweenEMTs’attributesandpatients’vitalsbeforeandaftertransportthroughregressionmodels

§ 48emergencycallswereincludedinfinalanalyses

§ EMTs’attributeswereevenlydistributedamongallincludedemergencymedicalcalls§ attire:professional(n=23),casual(n=25)§ number:=2EMT (n=24),or>2EMTs(n=24)§ gender(EMT-Pt):concordant(n=26),discordant(n=22) Figure1.Variationinpatients’vitalsbyattributesofemergencymedicaltechnicians

§ WhentheEMT’sgenderwasconcordanttothatofpatients,patientsexhibitedasignificantlyhighersystolicbloodpressurereadingbeforetransport(p<0.05),butnotaftertransport(p>0.05,Figure1C)

Appearances on Ambulances: Do Emergency Medical Technicians' Attire and Gender Affect Patients' Vitals during Prehospital Medical Emergencies?

Social and Decision Sciences

§ 48emergencycallswereincludedinfinalanalyses

§ Medicalsituationsincludedgeneralpain(31%),cardiacissues(19%),respiratoryissues(15%),psychologicalevaluations(8%),andothers(27%)

§ Patients had an average age of 50 years (range=20-85 years),and 56% were female

§ Patients’meanheartratewas98.1bpmbeforetransportand92.6bpmaftertransport

§ Patients’meanbloodpressure(systolic/diastolic)was144.7/88.1mmHgbeforetransportand140.7/87.4mmHgaftertransport

§ NorelationshipsbetweentheattireornumberofEMTsandpatients’vitalswereidentified(Figure1)

Conclusions§ Whenpatientsaremostvulnerable,EMTs’gendermay

elevatepatients’systolicbloodpressure,increasingtheirrisksofcardiovascularevents(e.g.,stroke,heartattack)

§ Ourexploratoryfindingswarrantfuturecorroborationinalarger,representativesample

§ OnlythencanweexplorewaystoreduceanyundueinfluenceofEMTs’attributesonprehospitalpatientcare

Limitations§ Astudywithinasinglesmall-townfirst-aidsquadmaynot

begeneralizabletolarger,regionalEMSagencies

§ Weexcluded severalemergencyscenarios:§ patientswhodidnotrequireoractivelyrefused

medicaltransporttothehospital§ patientsinemergencysituationsthathadrequired

police,fire,orALS

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