Guest guest Posted September 8, 2009 Report Share Posted September 8, 2009 Hey guys just wanted to pass this on to any fellow iphoners informed now has a copy of thier ALS field guide avalible for the iPhone I bought it and can say SAVE YOUR MONEY! It is nothing more than a PDF version of the guide in a PDF viewer they are charging $19 for it which in my opinion is way too much for something that can be done with a scanner and PDF veiwer software anyway the info is unchanged so I would suggest just getting a flipbook copy of the guide the iPhone version is really hard to navigate and I have yet to find a search menu. Just thought I would pass this along!! Have a great day! -Chris Sorry for the spelling and punctuation this was sent from my iPhone! > Dr Bledsoe, > > Interesting read. I do not agree though that admission to the > hospital would make the decision not to transport wrong. I would > like to see a study done that established actual harm coming to > patient because the Paramedic said ambulance not needed and sent > patient POV. > > Many patients could be safely treated and sent POV to the ER or > their doctors office. > > I know current payment guidelines thanks to some here would not > reimburse us for that type of care though. So financially it is not > feasible, but maybe with some efforts change in payment terms could > be made. > > Respectfully > Renny Spencer > > > > > Abstract > > Introduction. Reducing unnecessary ambulance transports may have > operational > > and economic benefits for emergency medical services (EMS) > agencies and > > receiving emergency departments. However, no consensus exists on > the ability > > of paramedics to accurately and safely identify patients who do > not require > > ambulance transport. Objective. This systematic review and meta- > analysis > > evaluated studies reporting U.S. paramedics' ability to determine > medical > > necessity of ambulance transport. Methods. PubMed, Cumulative > Index to > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library > > databases were searched using Cochrane Prehospital and Emergency > Care Field > > search terms combined with the Medical Subject Headings (MeSH) terms > > ³triage²; ³utilization review²; ³health services misuse²; > ³severity of > > illness index,² and ³trauma severity indices.² Two reviewers > independently > > evaluated each title to identify relevant studies; each abstract > then > > underwent independent review to identify studies requiring full > appraisal. > > Inclusion criteria were original research; emergency responses; > > determinations of medical necessity by U.S. paramedics; and a > reference > > standard comparison. The primary outcome measure of interest was the > > negative predictive value (NPV) of paramedic determinations. For > studies > > reporting sufficient data, agreement between paramedic and reference > > standard determinations was measured using kappa; sensitivity, > specificity, > > and positive predictive value (PPV) were also calculated. Results. > From > > 9,752 identified titles, 214 abstracts were evaluated, with 61 > studies > > selected for full review. Five studies met the inclusion criteria > > (interrater reliability, kappa = 0.75). Reference standards included > > physician opinion (n = 3), hospital admission (n = 1), and a > composite of > > physician opinion and patient clinical circumstances (n = 1). The > NPV ranged > > from 0.610 to 0.997. Results lacked homogeneity across studies; > > meta-analysis using a random-effects model produced an aggregate > NPV of > > 0.912 (95% confidence interval: 0.707-0.978). Only two studies > reported > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was > 0.992 and > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823. > > Conclusion. The results of the few studies evaluating U.S. paramedic > > determinations of medical necessity for ambulance transport vary > > considerably, and only two studies report complete data. The > aggregate NPV > > of the paramedic determinations is 0.91, with a lower confidence > limit of > > 0.71. These data do not support the practice of paramedics' > determining > > whether patients require ambulance transport. These findings have > > implications for EMS systems, emergency departments, and third- > party payers. > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 527 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2009 Report Share Posted September 8, 2009 Thanks I was thinking of getting it. Live for today, tomorrow is not here yet and laugh at yourself often before someone else does. McGee, EMT-P > Dr Bledsoe, > > Interesting read. I do not agree though that admission to the > hospital would make the decision not to transport wrong. I would > like to see a study done that established actual harm coming to > patient because the Paramedic said ambulance not needed and sent > patient POV. > > Many patients could be safely treated and sent POV to the ER or > their doctors office. > > I know current payment guidelines thanks to some here would not > reimburse us for that type of care though. So financially it is not > feasible, but maybe with some efforts change in payment terms could > be made. > > Respectfully > Renny Spencer > > > > > Abstract > > Introduction. Reducing unnecessary ambulance transports may have > operational > > and economic benefits for emergency medical services (EMS) > agencies and > > receiving emergency departments. However, no consensus exists on > the ability > > of paramedics to accurately and safely identify patients who do > not require > > ambulance transport. Objective. This systematic review and meta- > analysis > > evaluated studies reporting U.S. paramedics' ability to determine > medical > > necessity of ambulance transport. Methods. PubMed, Cumulative > Index to > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library > > databases were searched using Cochrane Prehospital and Emergency > Care Field > > search terms combined with the Medical Subject Headings (MeSH) terms > > ³triage²; ³utilization review²; ³health services misuse²; > ³severity of > > illness index,² and ³trauma severity indices.² Two reviewers > independently > > evaluated each title to identify relevant studies; each abstract > then > > underwent independent review to identify studies requiring full > appraisal. > > Inclusion criteria were original research; emergency responses; > > determinations of medical necessity by U.S. paramedics; and a > reference > > standard comparison. The primary outcome measure of interest was the > > negative predictive value (NPV) of paramedic determinations. For > studies > > reporting sufficient data, agreement between paramedic and reference > > standard determinations was measured using kappa; sensitivity, > specificity, > > and positive predictive value (PPV) were also calculated. Results. > From > > 9,752 identified titles, 214 abstracts were evaluated, with 61 > studies > > selected for full review. Five studies met the inclusion criteria > > (interrater reliability, kappa = 0.75). Reference standards included > > physician opinion (n = 3), hospital admission (n = 1), and a > composite of > > physician opinion and patient clinical circumstances (n = 1). The > NPV ranged > > from 0.610 to 0.997. Results lacked homogeneity across studies; > > meta-analysis using a random-effects model produced an aggregate > NPV of > > 0.912 (95% confidence interval: 0.707-0.978) . Only two studies > reported > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was > 0.992 and > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823. > > Conclusion. The results of the few studies evaluating U.S. paramedic > > determinations of medical necessity for ambulance transport vary > > considerably, and only two studies report complete data. The > aggregate NPV > > of the paramedic determinations is 0.91, with a lower confidence > limit of > > 0.71. These data do not support the practice of paramedics' > determining > > whether patients require ambulance transport. These findings have > > implications for EMS systems, emergency departments, and third- > party payers. > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 527 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2009 Report Share Posted September 8, 2009 Thanks I was thinking of getting it. Live for today, tomorrow is not here yet and laugh at yourself often before someone else does. McGee, EMT-P > Dr Bledsoe, > > Interesting read. I do not agree though that admission to the > hospital would make the decision not to transport wrong. I would > like to see a study done that established actual harm coming to > patient because the Paramedic said ambulance not needed and sent > patient POV. > > Many patients could be safely treated and sent POV to the ER or > their doctors office. > > I know current payment guidelines thanks to some here would not > reimburse us for that type of care though. So financially it is not > feasible, but maybe with some efforts change in payment terms could > be made. > > Respectfully > Renny Spencer > > > > > Abstract > > Introduction. Reducing unnecessary ambulance transports may have > operational > > and economic benefits for emergency medical services (EMS) > agencies and > > receiving emergency departments. However, no consensus exists on > the ability > > of paramedics to accurately and safely identify patients who do > not require > > ambulance transport. Objective. This systematic review and meta- > analysis > > evaluated studies reporting U.S. paramedics' ability to determine > medical > > necessity of ambulance transport. Methods. PubMed, Cumulative > Index to > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library > > databases were searched using Cochrane Prehospital and Emergency > Care Field > > search terms combined with the Medical Subject Headings (MeSH) terms > > ³triage²; ³utilization review²; ³health services misuse²; > ³severity of > > illness index,² and ³trauma severity indices.² Two reviewers > independently > > evaluated each title to identify relevant studies; each abstract > then > > underwent independent review to identify studies requiring full > appraisal. > > Inclusion criteria were original research; emergency responses; > > determinations of medical necessity by U.S. paramedics; and a > reference > > standard comparison. The primary outcome measure of interest was the > > negative predictive value (NPV) of paramedic determinations. For > studies > > reporting sufficient data, agreement between paramedic and reference > > standard determinations was measured using kappa; sensitivity, > specificity, > > and positive predictive value (PPV) were also calculated. Results. > From > > 9,752 identified titles, 214 abstracts were evaluated, with 61 > studies > > selected for full review. Five studies met the inclusion criteria > > (interrater reliability, kappa = 0.75). Reference standards included > > physician opinion (n = 3), hospital admission (n = 1), and a > composite of > > physician opinion and patient clinical circumstances (n = 1). The > NPV ranged > > from 0.610 to 0.997. Results lacked homogeneity across studies; > > meta-analysis using a random-effects model produced an aggregate > NPV of > > 0.912 (95% confidence interval: 0.707-0.978) . Only two studies > reported > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was > 0.992 and > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823. > > Conclusion. The results of the few studies evaluating U.S. paramedic > > determinations of medical necessity for ambulance transport vary > > considerably, and only two studies report complete data. The > aggregate NPV > > of the paramedic determinations is 0.91, with a lower confidence > limit of > > 0.71. These data do not support the practice of paramedics' > determining > > whether patients require ambulance transport. These findings have > > implications for EMS systems, emergency departments, and third- > party payers. > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 527 > > > > > > Quote Link to comment Share on other sites More sharing options...
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