PubMed Health⌕ Search

Biomedical subjects

D W Spaite

Publications and source records attributed to D W Spaite.

At least 19 recordsLinked to original sources
PubMed1999

Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ontario Prehospital Advanced Life Support.

STUDY OBJECTIVES: This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care. METHODS: This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses. RESULTS: From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8% of cardiac arrests were witnessed by citizens, 14.5% received bystander CPR, 25.6% received CPR by fire or police, and 38.2% had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5% overall and 8.8% for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95% confidence intervals): age.81 (. 73,.89), bystander-witnessed arrest 4.05 (2.78, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped.76 (.71,.82). CONCLUSION: This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and clearly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.

Adolescent↗
PubMed1998

The Ontario Prehospital Advanced Life Support (OPALS) Study: rationale and methodology for cardiac arrest patients.

The Ontario Prehospital Advanced Life Support Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period. The study will evaluate the incremental benefit of rapid defibrillation and prehospital Advanced Cardiac Life Support measures for cardiac arrest survival and the benefit of Advanced Life Support for patients with traumatic injuries and other critically ill prehospital patients. This article describes the OPALS study with regard to the rationale and methodology for cardiac arrest patients.

Cost-Benefit Analysis↗
PubMed1998

Prehospital advanced life support for major trauma: critical need for clinical trials.

A widely diverse body of information exists on the use of Advanced Life Support procedures by prehospital personnel. We compared and contrasted the literature that currently exists on this topic. We examined methodologies, results, and conclusions for each article. We also stress the need for critical clinical evaluations in this arena.

Clinical Trials as Topic↗
PubMed1998

EMS agenda for the future: where we are ... where we want to be. EMS Agenda for the Future Steering Committee.

During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the "EMS Agenda for the Future." Fourteen EMS attributes were identified as requiring continued development in order to realize the vision established within the Agenda. They are Integration of Health Services, EMS Research, Legislation and Regulation, System Finance, Human Resources, Medical Direction, Education Systems, Public Education, Prevention, Public Access, Communication Systems, Clinical Care, Information Systems, and Evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.

Emergency Medical Service Communication Systems↗
PubMed1997

Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model.

BACKGROUND: The study objective was to develop a simple, generalizable predictive model for survival after out-of-hospital cardiac arrest due to ventricular fibrillation. METHODS AND RESULTS: Logistic regression analysis of two retrospective series (n=205 and n=1667, respectively) of out-of-hospital cardiac arrests was performed on data sets from a Southwestern city (population, 415,000; area, 406 km2) and a Northwestern county (population, 1,038,000; area, 1399 km2). Both are served by similar two-tiered emergency response systems. All arrests were witnessed and occurred before the arrival of emergency responders, and the initial cardiac rhythm observed was ventricular fibrillation. The main outcome measure was survival to hospital discharge. Patient age, initiation of CPR by bystanders, interval from collapse to CPR, interval from collapse to defibrillation, bystander CPR/collapse-to-CPR interval interaction, and collapse-to-CPR/collapse-to-defibrillation interval interaction were significantly associated with survival. There was not a significant difference between observed survival rates at the two sites after control for significant predictors. A simplified predictive model retaining only collapse to CPR and collapse to defibrillation intervals performed comparably to the more complicated explanatory model. CONCLUSIONS: The effectiveness of prehospital interventions for out-of-hospital cardiac arrest may be estimated from their influence on collapse to CPR and collapse to defibrillation intervals. A model derived from combined data from two geographically distinct populations did not identify site as a predictor of survival if clinically relevant predictor variables were controlled for. This model can be generalized to other US populations and used to project the local effectiveness of interventions to improve cardiac arrest survival.

Adolescent↗
PubMed1997

Developing a foundation for the evaluation of expanded-scope EMS: a window of opportunity that cannot be ignored.

EMS systems are about to undergo a major transformation. Not only will the scope of EMS change, but many experts believe that it will dramatically expand. Some see the "expanded scope" as entailing relatively limited changes, whereas others consider them to be more broad. Although no agreement is evident about the definition for expanded-scope EMS, it is hoped that all EMS professionals can agree that it must be implemented in a manner that can be carefully evaluated to determine its effects on patients and EMS systems. We present a framework for evaluating the effect of expanded-scope EMS in the various types of systems that currently exist. Special consideration must be given to the indirect effects that system changes may have on survival from out-of-hospital cardiac arrest. Numerous issues will affect our ability to properly assess expanded-scope EMS. The basic research models necessary to assess the impact of system change are lacking. Few EMS systems consistently produce significant volumes of good systems research ... that is, there are few "EMS laboratories." Cost-effectiveness and issues surrounding the "societal value" of EMS remain essentially unstudied. Reliable scoring methods, severity scales, and outcome measures are lacking: and, it is ethically and logistically difficult to justify withholding the "standard of care" in an effort to understand the impact of EMS interventions. Despite all of these barriers, it is time to pay the price of doing methodologically sound evaluations that ensure the most optimal societal impact by the EMS systems of the future.

Clinical Trials as Topic↗
PubMed1997

Observational evaluation of compliance with traffic regulations among helmeted and nonhelmeted bicyclists.

STUDY OBJECTIVE: To evaluate whether helmeted bicyclists are more compliant with traffic regulations than nonhelmeted bicyclists. METHODS: This prospective observational study, using a convenience sample, was conducted during daylight hours at three separate intersections, marked with legal stop signs, near the campus of a major university. Data collected included helmet use, legal hand signal use to indicate a turn or stop, and whether the bicyclist came to a complete stop before proceeding through the intersection. RESULTS: A total of 1,793 bicyclists were evaluated. Only 8.8% of the bicycle riders were wearing helmets. Helmeted bicyclists were 2.6 times more likely than nonhelmeted bicyclists to make legal stops (P < .000001; odds ratio [OR], 3.1; 95% confidence interval [CI], 2.1 to 4.6). They were also 7.1 times more likely to use hand signals (P < .000001; OR, 7.2; 95% CI, 2.8 to 18.2). CONCLUSION: Helmeted bicycle riders showed a significantly greater compliance with two traffic laws than nonhelmeted bicyclists. They were 2.6 times more likely to stop at stop signs and 7.1 times more likely to use legal hand signals. This very strong association of helmet use with safer riding habits has implications for injury-control efforts aimed at preventing bicycle-related injuries.

Bicycling↗
PubMed1997

Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources.

BACKGROUND: Unlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States. METHODS: All deaths from blunt and penetrating trauma between November 15, 1991, and November 14, 1993, were included. As many as 150 variables were collected on each patient, including time of injury and time of death. Initial identification of cases was through manual review of death records. Information was supplemented by review of hospital records, case reports, and prehospital encounter forms. RESULTS: A total of 710 traumatic deaths were analyzed. Approximately half of the victims, 52%, were pronounced dead at the scene. Of the 48% who were hospitalized, the most frequent mechanism of injury was a fall. Neurologic dysfunction was the most common cause of death. Two distinct peaks of time were found on analysis: 23% of patients died within the first 60 minutes, and 35% of patients died at 24 to 48 hours after injury. CONCLUSIONS: Although there appears to continue to be a trimodal distribution of trauma deaths in urban environments, we found the distribution to be bimodal in an environment with a higher ratio of blunt to penetrating trauma.

Adult↗
PubMed1996

Analysis of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act.

STUDY OBJECTIVE: To identify the incidence of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act (COBRA). METHODS: Under the Freedom of Information Act, we retrieved a copy of any document related to fines imposed on, settlements made by, or litigation against physicians or hospitals as a result of COBRA violations from the Office of the Inspector General. Under a separate inquiry, also under the Freedom of Information Act, we requested and received from the central office of the Health Care Financing Administration the National Composite Log showing the status of all complaint investigations pursuant to COBRA since the inception of the law. RESULTS: One thousand seven hundred fifty-seven complaint investigations were authorized. Of the 1,729 investigations completed, 412 (24%) were found to be out of compliance with federal regulations. Of these, 27 cases resulted in fines imposed on hospitals. These fines ranged from $1,500 to $150,000 with a mean of $33,917, a median of $25,000, and standard deviation of $35,899. The six fines that were imposed against physicians ranged in value from $2,500 to $20,000 with a mean of $8,500, a median of $7,500, and an SD of $8,612. Seven hospitals but no physicians were terminated from the Medicare program for COBRA violations. CONCLUSION: The incidence of federally imposed penalties for COBRA violations is low given the multitude of patient transfers that have occurred since the enactment of COBRA. The growing concern regarding this issue may be related to current litigation efforts to broaden the scope and applications of these laws.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

Emergency medical service systems research: problems of the past, challenges of the future.

Out-of-hospital emergency care was designed around the concept of a system of interrelated events that combine to offer a patient the best care possible outside the hospital. However, in contrast to the actual operations of emergency medical service (EMS) systems, research has not typically used systems-based models as the method for evaluation. In this discussion we outline the weaknesses of component-based research models in EMS evaluation and attempt to provide a "systems-analysis" framework that can be used for future research. Incorporation of this multidiscipline approach into EMS research is essential if there is to be any hope of finding answers to many of the important questions that remain in the arena of out-of-hospital health care.

Emergency Medical Services↗
PubMed1995

Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated i.v. lines.

STUDY OBJECTIVE: To compare the risk of infection for i.v. lines placed in the prehospital versus in the in-hospital setting in a midsized emergency medical service system. DESIGN: A retrospective analysis was made of all i.v. line site infections among patients admitted to ward beds from a university hospital emergency department in 1992. METHODS: The hospital's infection control team conducted daily ward rounds and a surveillance of all wound and blood cultures. Patients with signs and/or symptoms consistent with Centers for Disease Control and Prevention guidelines for skin and soft tissue infection were reported to the responsible medical team. Infections were documented based on consensus opinion between the infection control team and the physicians responsible for the care of the patient. IV lines placed in the prehospital phase of care were identified by electronic retrieval from the prehospital database. RESULTS: Three thousand one hundred eighty-five patients who had a prehospital or an in-hospital i.v. line placed were admitted from the ED. Eight hundred fifty-nine i.v. lines were prehospital placed (27%), and 2,326 were in-hospital placed (73%). There was one infection in the prehospital group and four in the in-hospital group (infection rate: .0012 for prehospital patients and .0017 for in-hospital patients; P = .591 by Fisher's exact test). CONCLUSION: Both cohorts had exceptionally low infection rates. No clinically or statistically significant increase in the risk of infection among prehospital- or in-hospital-initiated i.v. lines was identified.

Arizona↗
PubMed1995

A prospective investigation of the impact of alcohol consumption on helmet use, injury severity, medical resource utilization, and health care costs in bicycle-related trauma.

STUDY OBJECTIVE: To examine if a relationship exists between bicycle-related injuries, consumption of alcohol, helmet use, and medical resource utilization. DESIGN: A prospective cohort study with data from emergency department, operating room, and inpatient records. SETTING: University-based trauma center in a medium-sized metropolitan area. TYPE OF PARTICIPANTS: Adult victims (age > or = 18 years) of bicycle-related injury presenting to the emergency department. A total of 350 patients made up the study population. RESULTS: Group 1 consisted of 29 patients (8.3%) with detectable blood alcohol levels at the time of the incident. Group 2 (321 patients) had a measured blood alcohol level of 0 or no clinical indication of alcohol consumption. Group 1 mean Injury Severity Score was 10.3, with six (20.7%) sustaining at least one severe anatomic injury. Group 2 had an Injury Severity Score of 3.3 (p < 0.0001), with only 4.4% (p = 0.0013) sustaining severe anatomic injury. Mean length of hospitalization for group 1 was 3.5 days, including a mean of 1.4 intensive care unit days. Mean hospitalization (0.5 days, p < 0.0001) and intensive care unit (0.1 days, p < 0.0001) were significantly lower in group 2. Mean combined hospital and physician charges were more than six times greater for group 1 ($7,206) than group 2 patients ($1170, p < 0.0001). CONCLUSION: In patients presenting with bicycle-related injuries, prior consumption of alcohol is highly associated with greater injury severity, longer hospitalization, and higher health care costs. This information is useful in the development of injury prevention strategies to decrease incidence and severity of adult bicycle injuries.

Accidents, Traffic↗
PubMed1994

A prospective in-field comparison of intravenous line placement by urban and nonurban emergency medical services personnel.

STUDY HYPOTHESIS: Emergency medical services personnel are highly proficient at rapid i.v. line placement in the prehospital setting, with little difference between urban and nonurban areas in a geographically diverse state. DESIGN: Prospective evaluation by an in-field observer of timing, sequence, success rates, and patient characteristics for IV line placement by prehospital personnel for 1 year. SETTING: Twenty advanced life support agencies from all four emergency medical service regions of Arizona. PARTICIPANTS: Fifty-eight patients encountered by participating emergency medical service agencies who had at least one i.v. line placement attempt in the prehospital setting. RESULTS: Urban agencies encountered 24 patients (41.4%), and nonurban agencies encountered 34 (58.6%). Fifty-seven of 58 patients (98.3%) had at least one successful i.v. line started before arrival at a hospital. All 24 urban patients and 33 of 34 nonurban patients (97.1%) had a successful i.v. line attempt (P = .586, power = .09). In the urban setting, 24 of 31 attempts (77.4%) were successful, and in the nonurban setting 35 of 52 attempts (67.3%) were successful (P = .464, power = .28). Mean i.v. line procedure intervals were 1.6 minutes in urban and 1.4 minutes in nonurban settings (P = .408, power = .7). Thirty of 31 i.v. line attempts (96.7%) were completed in less than 4 minutes in urban systems, and 49 of 52 IV line attempts (94.2%) were completed in less than 4 minutes in nonurban systems (P = .520, power = .13). Mean i.v. line procedure intervals were 1.3 minutes for successful attempts and 2.1 minutes for unsuccessful ones (P = .015). Mean i.v. line procedure intervals for on-scene attempts were 1.3 minutes compared with 2.0 minutes for attempts during transport (P = .005). On average, i.v. line attempts in trauma patients took only 1.0 minutes compared with 1.7 in medical patients (P = .017). CONCLUSION: Personnel in the 20 advanced life support agencies studied were extremely adept (rate of 98.3%) at obtaining i.v. line access in the prehospital setting. The time required to complete i.v. line placement was very short, and little difference was noted between urban and nonurban providers. I.v. procedure intervals were shorter for successful attempts, on-scene attempts, and attempts in trauma patients compared with their counterparts.

Adolescent↗
PubMed1993

Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: monitoring emergency medical services system performance in sudden cardiac arrest.

STUDY OBJECTIVE: To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest. STUDY DESIGN: A 22-month case series, collected prospectively, of out-of-hospital cardiac arrests. Times of collapse, dispatch, scene arrival, CPR, and initial defibrillation were determined from dispatch records, recordings of arrest events, interviews with bystanders, and hospital records. SETTING: Southwestern city (population, 400,000; area, 390 km2) with a two-tiered basic life support-advanced life support emergency medical services system. Emergency medical technician-firefighters without electrical defibrillation capability comprised the first response tier; firefighter-paramedics were the second tier. PATIENTS: One hundred eighteen cases of witnessed, out-of-hospital cardiac arrest in adults with initial ventricular fibrillation. MAIN OUTCOME MEASURES: Survival was defined as a patient who was discharged alive from the hospital. RESULTS: Eighteen of 118 patients (15%) survived. Survivors did not differ significantly from nonsurvivors in age, sex, or basic life support or advanced life support response intervals. Survivors had significantly (P < .05) shorter intervals from collapse to CPR (1.7 versus 5.2 minutes) and to defibrillation (7.4 versus 9.5 minutes). CONCLUSION: Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.

Aged↗