Improving Systems of Care in Time-Sensitive Emergencies

This report paved the way for modern EMS by recommending the creation of standards for ambulance services, training and oversight in prehospital medicine.1 Legendary physician R Adams Cowley is credited with creating and popularizing the concept of a "golden hour" in trauma, underscoring the need for coordination from the moment trauma occurs to the time to definitive care. Deficiencies in trauma care were recognized and trauma systems of care were developed with EMS playing a central role. As EMS evolved, so did the need to include EMS when developing systems of care for other time-sensitive emergencies. Cardiovascular disease, trauma, stroke and sepsis accounted for 925,000 deaths in the nation in 2014—equivalent to the population of Austin, Texas.2 As hospitals become specialized centers of excellence for ST elevation myocardial infarction (STEMI), stroke or sepsis, there are surrogate "golden hours": door-to-needle in < 60 minutes for tPA treatment of stroke; door-to-puncture in < 90 minutes for endovascular treatment of large vessel occlusion (LVO) stroke; and door-to-balloon times of < 90 minutes for STEMI, and other time-driven goals in acute sepsis care.3–7 In each of these emergencies, rapid diagnosis, stabilization and transport to an appropriate facility is associated with improved care and outcomes.
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Communications & Dispatch Source Type: news