PubMed Health⌕ Search

Biomedical subjects

Theodore R Delbridge

Publications and source records attributed to Theodore R Delbridge.

11 recordsLinked to original sources
PubMed2006

The role of law enforcement agencies in out-of-hospital emergency care.

BACKGROUND: A key component of out-of-hospital emergency care is the rapid response of trained providers with appropriate medical equipment. In some communities, law enforcement agents function as first responders to accomplish this goal. The purpose of this national survey was to assess the proportion of law enforcement agencies that provide medical care to determine the extent of care they provide, to identify how many use AEDs, and to assess the attitudes of agency leaders regarding their roles as medical first responders. METHODS: Eight hundred agencies were selected at random from a national database of 43,000 agencies available through the National Public Safety Bureau (Stevens Pt, WI). These agencies were sent a 19-question survey either by US mail or telephone. RESULTS: Four-hundred and fifty-four (57%) surveys were returned, and 420 (53%) were available for use after exclusion criteria were applied. Eighty percent of law enforcement agencies respond routinely to medical emergencies and 39% of these reported they deploy AEDs. Thirty-one percent of all law enforcement agencies are equipped with AEDs, a ten-fold increase from 2.6% reported in a previous national study in 1997. Funding issues were the most common reasons cited for not using AEDs. Approximately 75% of respondents agreed that law enforcement agencies should provide initial emergency medical care and indicated that officers in their agency would be willing to receive additional training to accomplish this. CONCLUSION: Based on this survey, law enforcement agents often serve as medical first responders. Nearly three quarters of responding agencies felt this role was appropriate. AEDs are now deployed much more frequently than indicated by a previous national study, but still less than one-third of law enforcement agencies carry AEDs as part of their standard response equipment.

Attitude↗
PubMed2005

Alcohol use disorder symptoms and risk-taking behavior as predictors of alcohol-related medical events among young adults treated in emergency departments.

BACKGROUND: Studies of alcohol-positive patients in emergency departments are not clear on the relationship between alcohol use disorder (AUD) symptoms and risk for injury. METHOD: Two-hundred three young adults (118 males (58%); mean age = 19.4 years) who were treated in two Level-1 emergency departments (ED) received comprehensive psychiatric interviews and completed the Alcohol Use Disorders Identification Test (AUDIT) and the Cognitive Appraisal of Risky Events (CARE). RESULTS: Males diagnosed with the AUD symptom of "drinking more or over a longer period than intended" are at greatest risk for requiring emergency care for an alcohol-related medical problem (OR = 10.8, 95% CI = 1.2,94.3, p < .04). Risk-taking behaviors increase risk for an alcohol-related medical event for both genders (OR = 2.6, 95% CI=1.1,5.6.1, p < .03). Alcohol use disorder severity related negatively to risk for experiencing an alcohol-related medical problem (OR = 0.6, 95% CI = 0.4,0.9, p < .04). CONCLUSIONS: Young adults treated for alcohol-related medical problems often exhibit DSM-IV defined symptoms of AUD and are engaging in risk-taking behaviors and should be referred for an in-depth assessment of alcohol use disorders and risk-taking activities.

Adolescent↗
PubMed2004

Predictors of problem drinking among older adolescent emergency department patients.

This study investigated consumption patterns, alcohol-related problems and predictors of problematic drinking among older adolescents. Two-hundred eighty older adolescents (148 males, mean +/- SD age = 18.5 [1.8] years) treated in two Emergency Departments (ED) completed the Alcohol Use Disorders Inventory Test (AUDIT) to identify problem drinkers. Logistic regression was used to determine predictors of problem drinker status. Higher rates of problem drinking were found among participants who were treated for physical assaults or for acute alcohol intoxication than were found among participants treated for medical illness. Being alcohol-positive in the ED, increasing frequency of drunkenness, and being treated for physical assault were predictive of problematic drinking after controlling for demographic variables. In conclusion, older adolescents who present for treatment of an assault-related injury or acute alcohol intoxication, who are alcohol-positive in the ED, and who report getting intoxicated once a month or more are likely to have a severe drinking problem.

Adolescent↗
PubMed2004

Alcohol use disorders among emergency department-treated older adolescents: a new brief screen (RUFT-Cut) using the AUDIT, CAGE, CRAFFT, and RAPS-QF.

BACKGROUND: Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV-defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents. METHODS: The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18-20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis. RESULTS: Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%). CONCLUSIONS: Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents.

Adolescent↗
PubMed2003

Psychiatric disorders among older adolescents treated in emergency departments on weekends: a comparison with a matched community sample.

OBJECTIVE: This study was undertaken to explore the characteristics of young patients treated in emergency departments (EDs) who follow through with an evaluation for psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and to investigate differences in rates of psychiatric disorders between ED-treated adolescents and demographically similar adolescents recruited from the community. METHOD: Sixty three older adolescents (40 males) who were treated at two urban university hospital EDs were matched one-to-one on age, gender and race with 63 adolescents recruited from the community for participation in studies at an alcohol research center. Comprehensive psychiatric interviews were conducted with both groups. RESULTS: ED-treated adolescents were diagnosed with higher rates of current alcohol use disorders (AUDs), current drug use disorders and current major depression than were community controls. The ED sample had a particularly high rate of the DSM-IV "hazardous use" of alcohol symptom. ED-treated adolescents also had a higher rate of lifetime comorbid alcohol use disorders and drug use disorders, as well as a higher rate of lifetime comorbid alcohol use disorders and major depression, compared with the community controls. CONCLUSIONS: Adolescents who are treated in EDs should be routinely assessed for the presence of AUD, drug involvement and depressive disorders.

Adolescent↗
PubMed2002

EMS ... agenda for the future.

In 1996, the National Highway Traffic Safety Administration and the Health Resources and Services Administration, Maternal and Child Health Bureau published the EMS Agenda for the Future. To date, thousands of copies have been distributed to EMS-knowledgeable people, and those who aspire to be, throughout the United States. This article reviews the findings discussed within the EMS Agenda for the Future. This discussion also assesses the effects of these findings on EMS development.

Emergency Medical Service Communication Systems↗
PubMedDate not supplied

Stroke: from recognition by the public to management by emergency medical services.

To improve the outcomes of stroke patients, public awareness of stroke must be increased and emergency medical services (EMS) response to stroke calls optimized. Rapid response to stroke is key, as emphasized in the American Stroke Association's "Stroke Chain of Survival," which consists of four components--rapid recognition of and reaction to stroke warning signs through immediate use of the 9-1-1 system; rapid EMS assessment; priority transport with prenotification of the receiving hospital; and rapid and accurate diagnosis and treatment at the hospital. Neither the risk factors for stroke nor the most common warning signs are adequately known to the public in general, and in particular, to the groups at highest risk for stroke. Effective education through mass media and health care professionals is paramount in increasing the public's awareness of stroke. Whether tools to aid dispatchers and paramedics in stroke diagnosis, assessment, and management can improve stroke patients' outcomes requires further study, as does the value of designated stroke centers. Overall, according stroke the same urgency as acute myocardial infarction, from both the public and the prehospital provider perspectives, might improve stroke patient outcomes.

Emergency Medical Services↗
PubMedDate not supplied

EMS and emergency department physician triage: injury severity in trauma patients transported by helicopter.

BACKGROUND: Many trauma patients who are not severely injured arrive at trauma centers via helicopter emergency medical services (HEMS). OBJECTIVE: To compare the injury severity of patients sent to trauma centers by HEMS from community emergency departments (EDs) with the injury severity of those triaged by prehospital providers to HEMS directly from accident scenes. METHODS: All records were reviewed from trauma-related missions during 1997for a single HEMS system, extracting information on location, time of day, patient age and gender, mechanism of injury, initial vital signs, Revised Trauma Score (RTS), and the extent of care required during transport. These records were then matched with outcome information routinely supplied to the HEMS system by affiliated trauma centers. Information from patients flown directly from scenes was then compared with that for patients flown from community EDs. RESULTS: Information was obtained for 658 patients flown from scenes and 345 flown from community EDs. There were similar proportions of patients in the two groups, with Injury Severity Scale (ISS) scores less than 6 (11.0% vs. 13.5%), between 6 and 14 (47.0% vs. 49.3%), and greater than 15 (42.0% vs. 37.1%); these were not statistically different (p > 0.05). There was also no significant difference between the groups in the RTS, mean ISS score, intensive care unit length of stay, hospital length of stay, or disposition. CONCLUSIONS: Scene and interhospital HEMS trauma missions in this system involve patients of similar injury severities. Prehospital providers may triage trauma patients to HEMS transport with proficiency similar to that of community ED physicians.

Air Ambulances↗
PubMedDate not supplied

Evolution of statewide EMS drug formularies and regulations.

OBJECTIVE: To characterize and follow the variability present in statewide emergency medical services (EMS) medication formularies across the United States over a ten-year period. METHODS: Investigators contacted the lead EMS agencies in all 50 states during three years (1992, 1997, and 2002). Using a standardized form, the investigators collected information about each state's prehospital medication policies, including whether a statewide EMS medication formulary existed, the authority of local medical directors to modify it, and what medications it contained. The investigators then sorted states into categories based on the regulatory intent of their EMS medication policies and compared medication listings across years. RESULTS: Responses were obtained from all 50 states (n = 50, 100%) during each of the survey periods. There appeared to be a trend toward stricter state control and toward less variation between statewide formularies. State regulations in seven states stopped allowing local medical directors to retain full control of their systems' formularies, and eight states implemented mandatory statewide formularies. There was a trend toward more consistency between states, with more "most commonly" listed medications (6.9% in 1992 versus 22.1% in 2002) and fewer "least commonly" listed medications (58.3% in 1992 versus 42.3% in 2002). Controversial medications such as neuromuscular blockers and thrombolytics appeared in a small but increasing number of statewide formularies. CONCLUSIONS: Considerable variation was found among statewide EMS medication formularies, both in how they were established and in their contents. Although several states continued to rely solely on local medical direction, there seemed to be a trend toward more uniformity and stricter state control over prehospital medication formularies during the study period.

Emergency Medical Services↗