Availability and Accuracy of EMS Information about Chronic Health and Medications in Cardiac Arrest
Abstract
Introduction: Field information available to emergency medical services (EMS) about a patient’schronic health conditions or medication therapies could help direct patient care or be used toinvestigate outcome disparities. However, little is known about the field availability or accuracy ofinformation of chronic health conditions or chronic medication treatments in emergent circumstances,especially when the patient cannot serve as an information resource. We evaluated the prehospitalavailability and accuracy of specific chronic health conditions and medication treatments among outof-hospital cardiac arrest (OHCA) patients.
Methods: The investigation was a retrospective cohort study of adult persons suffering ventricularfibrillation OHCA treated by EMS in a large metropolitan county from January 1, 2007, to December31, 2013. The study was designed to determine the availability and accuracy of EMS ascertainmentof selected chronic health conditions and medication treatments. We evaluated chronic healthconditions of “any heart disease,” congestive heart failure (CHF), and diabetes and medicationtreatments of beta blockers and loop diuretics using two distinct sources: 1) EMS report, and 2)hospital record specific to the OHCA event. Because hospital information was considered the goldstandard, we restricted the primary analysis to those who were admitted to hospital.
Results: Of the 1,496 initially eligible patients, 387 could not be resuscitated and were pronounceddead in the field, one patient was left alive at scene due to Physician’s Orders for Life-sustainingTreatment (POLST) orders, 125 expired in the emergency department (n=125), and 983 wereadmitted to hospital. A total of 832 of 1,496 (55.6%) had both sources of data for comparisonand comprised the primary analytic group. Using the hospital record as the gold standard, EMSascertainment had a sensitivity of 0.79 (304/384) and a specificity of 0.88 (218/248) for any priorheart disease; sensitivity 0.45 (47/105) and specificity 0.87 (477/516) for CHF; sensitivity 0.71(143/201) and specificity 0.98 (416/424) for diabetes; sensitivity 0.70 (118/169) and specificity 0.94(273/290) for beta blockers; sensitivity 0.70 (62/89) and specificity 0.97 (358/370) for loop diuretics.
Conclusion: In this cohort of OHCA, information about selected chronic health conditions andmedication treatments based on EMS ascertainment was available for many patients, generallyrevealing moderate sensitivity and greater specificity. [West J Emerg Med. 2017;18(5)864-869.]