Career and treatment attitudes related to potential human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) exposure are reported based on a survey of 1,228 Maryland career and volunteer prehospital care providers trained to provide basic (BLS) and advanced (ALS) life support. Sixty-five percent stated potential exposure to HIV/AIDS was a major occupational stressor. Ninety-two percent stated they would treat HIV/AIDS patients if protected. Given a choice, 38% would avoid providing treatment to HIV/AIDS patients. Eighteen percent considered resigning from emergency medical services (EMS) work. An attitudinal scale (AIDSTRESS) was developed to evaluate overall treatment and career reactions. Respondents with significantly higher (more negative reactions) AIDSTRESS scores were: BLS providers, men, paid providers, personnel with more than 3 years of field experience, those working in urban areas, personnel with no formal education beyond high school, and those who stated that their HIV/AIDS training was inadequate. Implications of the findings for quality of care, career decision making, and inservice education are discussed.

Adolescent↗

PubMed1991

Assuring quality from the ground up.

Does your EMS system rely primarily on run-sheet reviews and medical-protocol compliance to ensure systemwide quality assurance? If so, other aspects of your service may be neglected. Provider-based quality assurance stresses employee-instituted assessment and improvement of all aspects of a system's operation.

Decision Making, Organizational↗

PubMed1991

Decoding research terminology.

Explore the source record for details and available documents.

Emergency Medical Services↗

PubMed1991

Trauma care reimbursement: comparison of DRGs to an injury severity-based payment system.

Concern exists that per case payment using Diagnosis Related Groups (DRGs) inadequately pays trauma centers. In this study, 45 Trauma Resource Groups (TRGs), an alternative patient classification system based on the Injury Severity Score and patient age, is developed and compared to 172 Diagnosis Related Groups (DRGs) that include trauma diagnoses. TRGs were developed using 1983 Maryland trauma patient hospital discharge abstracts (n= 34,702), the same source used to assign a DRG. We compared estimated TRG and DRG payments to actual charges for 17,398 trauma cases treated during 1986 at five trauma centers and 18 community hospitals in the Central Maryland Metropolitan Statistical Area. The unexpected findings of this study are that an anatomic severity-based classification of hospital trauma discharges (TRGs) does not perform as well as DRGs in: 1) explaining variations in length of stay for trauma cases, or 2) assuring an appropriate distribution of revenues to regional trauma centers and community hospitals. Solutions discussed include segregating community hospital and trauma center costs in computation of average per case rate setting, and inclusion of physiologic and mechanism of injury parameters in prospective payment classification systems to increase explained variance of resource use.

Diagnosis-Related Groups↗

PubMed1989

Prehospital providers' AIDS knowledge and attitudes.

Of the 110 career and volunteer prehospital care providers surveyed from two Maryland counties, about 20 percent were concerned about dealing with AIDS patients, including 24 percent who have considered leaving EMS due to the risk of HIV infection.

Acquired Immunodeficiency Syndrome↗

PubMed1985

Rating AIS severity using emergency department sheets vs. inpatient charts.

To determine whether sufficiently accurate estimates of injury severity can be based on limited data as would be available from an Emergency Department (ED) Sheet, Abbreviated Injury Severity (AIS) scores were derived for 166 trauma patients using two different sources of data--the ED sheet and inpatient medical chart. These severity scores were compared by type of person assigning the scores and by external cause of the injury. Results indicate that in general, the ED sheet is not a suitable alternative to the complete inpatient chart when coding severity for individuals who sustain injuries severe enough to result in hospital admission.

Diagnosis-Related Groups↗

PubMed1985

The Abbreviated Injury Scale and Injury Severity Score. Levels of inter- and intrarater reliability.

Given the wide usage and proven value of the Abbreviated Injury Scale (AIS) in rating severity of trauma, it is essential that certain reliability issues concerning its application be resolved. This article describes a study designed to address these reliability issues. Each of 15 raters with varying qualifications was asked to identify AIS code injuries sustained by 375 trauma patients admitted to four Baltimore area hospitals. Results showed that as a group, physicians and nurses tend to be more reliable in their ratings than either emergency medical technicians (EMTs) or nonclinical technicians, although a research assistant who is well trained in AIS coding and is a diligent worker can use the AIS to code severity as reliably as the physicians when sufficient information is provided in the medical chart. Reliability of AIS scoring was somewhat higher for blunt (vehicular and nonvehicular) versus penetrating injuries.

Costs and Cost Analysis↗