Biomedical subjects

P A Curka

Publications and source records attributed to P A Curka.

6 recordsLinked to original sources

PubMed1995

Incidence, source, and nature of complaints received in a large, urban emergency medical services system.

OBJECTIVE: To document the incidence, source, and reasons for all complaints received by a large municipal emergency medical services (EMS) program. METHODS: A retrospective review of all complaints received during three consecutive years (1990-1992) in a centralized EMS system serving a large municipality (population 2 million). All cases were categorized by year, source, and nature of the complaint. RESULTS: In the three study years, EMS responded to 416,892 incidents with nearly a half-million patient contacts. Concurrently, 371 complaints were received (incidence of 1.12 per thousand); 132 in 1990, 129 in 1991, and 110 in 1992. Most complaints involved either: 1) allegations of "rude or unprofessional conduct" (34%), 2) "didn't take patient to the hospital" (19%), or 3) "problems with medical treatment" (13%). Only 1.6% (n = 6) were response-time complaints. Other complaints included "lost/damaged property," "taken to the wrong hospital," "inappropriate billing," and "poor driving habits." The most common sources were patient's families (39%) and the patients themselves (30%). Only 7.8% were from health care providers. CONCLUSION: Reviews of complaints provide information regarding EMS system performance and reveal targets for quality improvement. For the EMS system examined, this study suggests a future training focus on interpersonal skills and heightened sensitivities, not only toward patients, but also toward bystanders and family members.

Consumer Behavior↗

PubMed1995

How to monitor the effectiveness of an emergency medical dispatch system: the Houston model.

The use of priority dispatch systems for emergency medical services (EMS) is widespread throughout the United States and in several other countries. It is essential that any such system be monitored to prove that it is safe and effective. A study of the EMS system in Houston, Texas, USA, has previously reported that the priority dispatch system can safely and reliably identify EMS incidents requiring only basic life support; the methods by which this was achieved are outlined here. In addition, the current and pending revisions to the Houston Fire Department Dispatch Quality Management Programme are discussed.

Emergency Medical Service Communication Systems↗

PubMed1993

Emergency medical services priority dispatch.

STUDY OBJECTIVE: To test the ability of a locally designed priority dispatch system to safely exclude the need for advanced life support (ALS). DESIGN: Retrospective review of emergency medical services (EMS) incident records to determine how often the lone dispatch of basic life support (BLS) units, staffed with basic emergency medical technicians, subsequently required or involved ALS care. SETTING: A large centralized municipal EMS system with a tiered ALS/BLS ambulance response. All BLS units carry automated defibrillators. MEASUREMENTS: Consecutive EMS records (35,075) were reviewed by computerized search for ALS procedures. Records indicating ALS procedures were tabulated and then manually reviewed for the nature of and probable indication for the ALS intervention. INTERVENTION: Brief sequences of computer-stored questions that help dispatchers identify (or exclude) signs and symptoms indicating the need for ALS. RESULTS: The dispatch triage system spared ALS units from initial dispatch in 14,100 of the EMS incidents (40.2%), increasing their availability and use for more serious calls. Among these 14,100 cases, only 41 patients (0.3%) later received drugs such as nitroglycerin and naloxone; another 27 patients (0.2%) received resuscitative interventions such as epinephrine or defibrillation. Furthermore, on closer analysis, the immediate presence of a paramedic might have provided a true potential for advantage in outcome for only five or six patients (less than 0.04 of the 14,100 BLS dispatches). Meanwhile, many important operational, fiscal, and cost-effective patient care benefits were realized with this system. CONCLUSION: A computer-aided dispatch triage algorithm can facilitate improvements in both EMS system operations and prehospital patient care by safely and reliably identifying EMS incidents requiring only BLS.

Algorithms↗

PubMed1993

Cardiac arrest presenting with rhythms other than ventricular fibrillation: contribution of resuscitative efforts toward total survivorship.

OBJECTIVE: The medical literature portrays a bleak prognosis for out-of-hospital cardiac arrest cases presenting with asystole, idioventricular rhythms with pulselessness, or primary electromechanical dissociation. In view of evolving philosophies to waive resuscitation attempts in such cases, we sought to delineate the actual contribution toward overall survivorship that is provided by resuscitation efforts for patients who have these electrocardiographic presentations. DESIGN: A prospective outcome study which analyzed all out-of-hospital cardiac arrest cases in a large city for a 2-yr period in terms of presenting electrocardiogram, age, sex, presence and status of witnesses, performance of bystander cardiopulmonary resuscitation, and survival to successful hospital discharge. SETTING: A large urban municipality (population, two million) served by a single, centralized emergency medical services program. PATIENTS: Excluding cases associated with trauma, drugs, airway obstruction, submersion or primary respiratory illness, 2,404 consecutive adult out-of-hospital cardiac arrest patients were studied. INTERVENTIONS: Standard advanced cardiac life support. MEASUREMENTS AND MAIN RESULTS: Although survival "rates" of patients with asystole, idioventricular rhythms with pulselessness, and electromechanical dissociation were low (1.6%, 4.7% and 6.9%, respectively), 22.2% of the 193 total survivors (confidence interval: +5.9%) initially presented with one of these electrocardiographic rhythms (14 asystole, 18 idioventricular rhythms with pulselessness, 10 electromechanical dissociation, plus one other). CONCLUSIONS: Despite poor survival "rates," resuscitative efforts for patients presenting with asystole, electromechanical dissociation, and idioventricular rhythms with pulselessness all contribute significantly toward a community's total survivorship from out-of-hospital cardiac arrest. Initial, aggressive attempts at resuscitation still should be emphasized in such patients.

Accelerated Idioventricular Rhythm↗

PubMed1992

Prospective evidence of a circadian rhythm for out-of-hospital cardiac arrests.

OBJECTIVES: Published studies have indicated a circadian rhythm in the occurrence of sudden cardiac death. However, these studies have involved either retrospective analyses of death certificates or analyses of data collected during studies of pharmacologic agents in selected populations. PURPOSE: To determine whether a circadian pattern could be clearly demonstrated in a prospective study of out-of-hospital sudden cardiac death in a large, unselected population. DESIGN: All adult cases of sudden death of presumed primary cardiac cause from a large urban population were prospectively evaluated over a 12-month period. The incidence of sudden cardiac death was analyzed using harmonic regression of the data tabulated by hour of the day. RESULTS: During the year of study, 1019 consecutive primary cardiac arrests were analyzed. A significant circadian pattern was found (P less than .0001) with the frequency of cardiac arrests increasing dramatically from 6 AM until noon. CONCLUSIONS: This prospective study of out-of-hospital cardiac arrest confirms the existence of a circadian rhythm. These data have important implications for future investigations concerning the pathophysiology of sudden cardiac deaths.

Ambulatory Care↗

PubMed1989

High-pressure water injection injury to the hand.

An 84-year-old man presented with a high-pressure injection injury of the left thumb. The hand-held water gun involved generates less pressure than the grease and paint sprayers usually involved in these injuries. The patient was managed conservatively in the hospital with elevation, observation, and dressing changes. Surgical debridement was not required. This case points out a previously unrecognized hazard of these devices, particularly to older individuals with atrophic skin.

Aged↗