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Article: Evolution of a high-performance emergency health services system in Nova Scotia.

Travers, Andrew H

2018 Volume 31, Issue 5, Page(s) 191–195

Abstract: Since 1997, Emergency Health Services in Nova Scotia (NS) has evolved from a program providing prehospital care for patients in transport to a system providing integrated healthcare in both traditional (ie, ambulance) and non-traditional settings (eg, ... ...

Abstract	Since 1997, Emergency Health Services in Nova Scotia (NS) has evolved from a program providing prehospital care for patients in transport to a system providing integrated healthcare in both traditional (ie, ambulance) and non-traditional settings (eg, patient homes, hospital settings). This article highlights (1) the reorganization of the emergency medical service system design, (2) the strategies enabling efficient operation of this design, and (3) resultant innovations evolving from both system redesign and strategy application. Emergency Health Services has utilized a Public Utility Model (PUM) design providing prehospital healthcare, public safety, and public health responses to the population of NS. The success of the PUM has been complimented by three strategies: (1) co-leadership model operations, (2) common languages to translate evidence into practice, and (3) collaborative and integrated relationships with other regulated healthcare providers. This prehospital system design and application strategies could be applied in other sectors of community and hospital systems of care.
MeSH term(s)	Delivery of Health Care, Integrated/organization & administration ; Emergency Medical Services/organization & administration ; Emergency Medical Services/standards ; Humans ; Nova Scotia ; Organizational Innovation
Language	English
Publishing date	2018-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2140831-2
ISSN	2352-3883 ; 0840-4704
ISSN (online)	2352-3883
ISSN	0840-4704
DOI	10.1177/0840470418773416
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Care begins when 9-1-1 is called: the evolving role of paramedic specialists in EMS Medical Communications Centres.

Jensen, Jan L / Travers, Andrew H / Carter, Alix J E

CJEM

2022 Volume 24, Issue 2, Page(s) 115–116

MeSH term(s)	Allied Health Personnel ; Emergency Medical Technicians ; Hospitals ; Humans
Language	English
Publishing date	2022-03-08
Publishing country	England
Document type	Editorial ; Comment
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-022-00284-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The Human Embryo: A Brief Biological and Philosophical Biography.

Nerland, Andrew / Bhagia, Amrita / Travers, Henry

South Dakota medicine : the journal of the South Dakota State Medical Association

2023 Volume 76, Issue 6, Page(s) 272–281

Language	English
Publishing date	2023-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2278073-7
ISSN	0038-3317
ISSN	0038-3317
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Article: Evaluating the Impact of a Novel Mobile Care Team on the Prevalence of Ambulatory Care Sensitive Conditions Presenting to Emergency Medical Services in Nova Scotia.

Brown, Ryan / Goldstein, Judah / Jensen, Jan L / Travers, Andrew H / Carter, Alix

Cureus

2023 Volume 15, Issue 4, Page(s) e37280

Abstract: Introduction: Hospitalization due to ambulatory care sensitive conditions (ACSC) is a proxy measure for access to primary care. Emergency Medical Services (EMS) are increasingly called when primary care cannot be accessed. A novel paramedic-nurse EMS ... ...

Abstract	Introduction: Hospitalization due to ambulatory care sensitive conditions (ACSC) is a proxy measure for access to primary care. Emergency Medical Services (EMS) are increasingly called when primary care cannot be accessed. A novel paramedic-nurse EMS Mobile Care Team (MCT) was implemented in an under-serviced community. The MCT responds in a non-transport unit to referrals from EMS, emergency and primary care, and to low-acuity 911 calls in a defined geographic region. Our objective was to compare the prevalence of ACSC in ground ambulance (GA) responses before and after the introduction of the MCT. Methods: A cross-sectional analysis of GA and MCT patients with ACSC (determined by chief complaint, clinical impression, treatment protocol, and medical history) from one year pre-MCT implementation to one year post-MCT implementation was conducted for the period of October 1, 2012, to September 30, 2014. Demographics were described. ACSC prevalence was compared using the chi-squared test. Results: There were 975 calls pre-MCT and 1208 GA/95 MCT calls post-MCT. ACSC in GA patients pre- and post-MCT was similar: n=122, 12.5% vs. n=185, 15.3%; p=0.06. ACSC in patients seen by EMS (GA plus MCT) increased in the post-MCT period: 122 (12.5%) vs. 204 (15.7%) p=0.04. Pre-MCT implementation vs post-implementation, GA ACSC calls differed significantly by sex with higher female utilization (n=50 vs. n=105; p=0.007), but not age (65.38, ± 15.12 vs. 62.51 ± 20.48; p=0.16) Conclusion: The prevalence of ACSC did not decrease for GA with the introduction of the MCT, but ACSC in the overall patient population served by EMS increased. It is possible more patients with ACSC call, or are referred to EMS, for the new MCT service. Given that MCT patients were less likely to have a primary care provider, this may represent an increase in access to care or a shift away from other emergency/episodic care. These associations must be further studied to inform the ideal utility of adding such services to EMS and healthcare systems.
Language	English
Publishing date	2023-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.37280
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Abortion and The Hippocratic Oath: Historical Aspects.

Bhagia, Amrita / Nerland, Andrew / van Kalsbeek, Mitchell / Travers, Henry

South Dakota medicine : the journal of the South Dakota State Medical Association

2023 Volume 75, Issue 9, Page(s) 410–412

MeSH term(s)	Female ; Pregnancy ; Humans ; Hippocratic Oath ; Abortion, Spontaneous
Language	English
Publishing date	2023-03-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2278073-7
ISSN	0038-3317
ISSN	0038-3317
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Article ; Online: Environmental and structural factors driving poor quality of care: An examination of nursing homes serving Black residents.

Travers, Jasmine L / Castle, Nicholas / Weaver, Susan H / Perera, Uduwanage G / Wu, Bei / Dick, Andrew W / Stone, Patricia W

Journal of the American Geriatrics Society

2023 Volume 71, Issue 10, Page(s) 3040–3048

Abstract: Background: Poor quality of care in nursing homes (NHs) with high proportions of Black residents has been a problem in the US and even more pronounced during the COVID-19 pandemic. Federal and state agencies are devoting attention to identifying the ... ...

Abstract	Background: Poor quality of care in nursing homes (NHs) with high proportions of Black residents has been a problem in the US and even more pronounced during the COVID-19 pandemic. Federal and state agencies are devoting attention to identifying the best means of improving care in the neediest facilities. It is important to understand environmental and structural characteristics that may have led to poor healthcare outcomes in NHs serving high proportions of Black residents pre-pandemic. Methods: We conducted a cross-sectional observational study using multiple 2019 national datasets. Our exposure was the proportion of Black residents in a NH (i.e., none, <5%, 5%-19.9%, 20-49.9%, ≥50%). Healthcare outcomes examined were hospitalizations and emergency department (ED) visits, both observed and risk-adjusted. Structural factors included staffing, ownership status, bed count (0-49, 50-149, or ≥150), chain organization membership, occupancy, and percent Medicaid as a payment source. Environmental factors included region and urbanicity. Descriptive and multivariable linear regression models were estimated. Results: In the 14,121 NHs, compared to NHs with no Black residents, NHs with ≥50% Black residents tended to be urban, for-profit, located in the South, have more Medicaid-funded residents, and have lower ratios of registered-nurse (RN) and aide hours per resident per day (HPRD) and greater ratios of licensed practical nurse HPRD. In general, as the proportion of Black residents in a NH increased, hospitalizations and ED visits also increased. Discussion/implications: As lower use of RNs has been associated with increased ED visits and hospitalizations in NHs generally, it is likely low RN use largely drove the differences in hospitalizations and ED visits in NHs with greater proportions of Black residents. Staffing is an area in which state and federal agencies should take action to improve the quality of care in NHs with larger proportions of Black residents.
MeSH term(s)	United States ; Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology ; Nursing Homes ; Hospitalization
Language	English
Publishing date	2023-06-12
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18459
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Article: Contemporary evidence-based practice in Canadian emergency medical services: a vision for integrating evidence into clinical and policy decision-making.

Jensen, Jan L / Travers, Andrew H

CJEM

2017 Volume 19, Issue 3, Page(s) 220–229

Abstract: Nationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and ... ...

Abstract	Nationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals. This vision can be implemented with the use of a structure, process, system, and outcome taxonomy to identify current barriers to true EBP, to recognize the opportunities that exist, and propose corresponding recommended strategies for local EMS agencies and at the national level. Framing local and national discussions with this approach will be useful for developing a cohesive and collaborative Canadian EBP strategy.
Language	English
Publishing date	2017-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2059217-6
ISSN	1481-8035 ; 1481-8035 ; 1488-1543
ISSN (online)	1481-8035
ISSN	1481-8035 ; 1488-1543
DOI	10.1017/cem.2016.364
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Article: Potential Candidates for Emergency Department Initiated Extracorporeal Cardiopulmonary Resuscitation (ECPR) in a Canadian Institution.

Gould, James / Goldstein, Judah / Travers, Andrew H / Swain, Janel M / Carter, Alix / Rollo, Derek / Mekwan, Jay / Atkinson, Paul / Kovacs, George

Cureus

2022 Volume 14, Issue 9, Page(s) e29318

Abstract: Introduction Out-of-hospital cardiac arrest (OHCA) patients experience poor survival. The use of extracorporeal membrane oxygenation (ECMO), a form of heart-lung bypass, in the setting of cardiac arrest, termed extracorporeal cardiopulmonary ... ...

Abstract	Introduction Out-of-hospital cardiac arrest (OHCA) patients experience poor survival. The use of extracorporeal membrane oxygenation (ECMO), a form of heart-lung bypass, in the setting of cardiac arrest, termed extracorporeal cardiopulmonary resuscitation (ECPR), has promise in improving survival with good neurologic outcomes. The study objective was to determine the number of potential annual ECPR candidates among the OHCA population in a health region within the Atlantic Canadian province of Nova Scotia. Methods A retrospective chart review was conducted over a five-year period: January 1st, 2012 to December 31st, 2016. Consecutive non-traumatic OHCA and emergency department (ED) cardiac arrests occurring in a pre-determined catchment area (20-minute transport to ECMO center) defined by a geographic bounding box were identified. Criteria for ECPR were developed to identify candidates for activation of a "Code ECPR": (1) age 16-70, (2) witnessed arrest, (3) no flow duration (time to CPR, including bystander) <10 minutes, (4) resuscitation >10 minutes without return of spontaneous circulation (ROSC), (5) emergency medical service (EMS) transport to hospital <20 minutes, (6) no patient factors precluding ongoing resuscitation (do not resuscitate status (DNR), palliative care involvement, or metastatic cancer), and (7) initial rhythm not asystole. Candidates were stratified by initial rhythm. Candidates were considered ultimately ED ECPR eligible if they failed conventional treatment, defined by death or resuscitation >30 minutes. Clinical data related to candidacy was extracted by an electronic query from prehospital and ED electronic records and manual chart review by three researchers. Results Our search yielded 561 cases of EMS-treated OHCA or in-ED arrests. Of those 204/561 (36%; 95% CI 33-40%) met the criteria for activation of a "Code ECPR". Ultimately 79/204 (34%; 95% CI 28-41%) of those who met activation criteria were considered ED ECPR eligible; which is 14% (95% CI 11-17%) of the total number of arrests-of the total number of arrests, the initial rhythms were pulseless electrical activity (PEA) 33/79 (42%; 95% CI 32-53%) and shockable 46/79 (58%; 95% CI 47-69%). Conclusion Of all cardiac arrests in the area surrounding our ECMO center, approximately 41 per year met the criteria for a Code ECPR activation, with 16 per year ultimately being eligible for ED ECPR. This annual estimate varies based on the inclusion of initial rhythm. This provides insight into both prehospital and hospital implications of an ED ECPR program and will help guide the establishment of a program within our Nova Scotian health region. This study also provides a framework for similar investigation at other institutions contemplating ED ECPR program implementation.
Language	English
Publishing date	2022-09-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.29318
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Fatal Accidental Drowning in Minnehaha County, South Dakota, 1880-1939.

Schulte, Lillian / Petersen, Emily / O'Connor, Hunter / Mohs, Joshua / Reuter, Andrew / Travers, Henry

South Dakota medicine : the journal of the South Dakota State Medical Association

2022 Volume 76, Issue 10, Page(s) 465–474

Abstract: Drowning is currently the second leading cause of injury-related death for children 1-4 years of age in the United States and is the leading cause of death worldwide for boys ages 5-14 years. The World Health Organization (WHO) classifies it as a public ... ...

Abstract	Drowning is currently the second leading cause of injury-related death for children 1-4 years of age in the United States and is the leading cause of death worldwide for boys ages 5-14 years. The World Health Organization (WHO) classifies it as a public health threat and advocates for reducing drowning deaths by understanding geographical, cultural, and societal risk factors. To these three we added a fourth: historical studies. To that end, we analyzed accidental causes of death between January 1, 1880, and December 31, 1939, in Minnehaha County, South Dakota, based on interment records from the Mt. Pleasant Cemetery. From these six decades (1880-1939) of data, we classified 217 cases as accidental deaths. Drowning was the leading cause of accidental mortality, accounting for 50 accidental deaths (23%). Drowning deaths were analyzed by the decedents' age and date of death. We discuss specific historical drowning risk factors and hypothesize how they may have affected drowning deaths from 1880-1939 in Minnehaha County.
MeSH term(s)	Child ; Male ; Humans ; Infant ; Child, Preschool ; Adolescent ; Drowning/epidemiology ; South Dakota/epidemiology ; Cause of Death ; Risk Factors ; Medical History Taking
Language	English
Publishing date	2022-10-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2278073-7
ISSN	0038-3317
ISSN	0038-3317
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Article: Myocarditis in Minnehaha County, South Dakota, 1880-1939.

Petersen, Emily / Schulte, Lillian / O'Connor, Hunter / Reuter, Andrew / Mohs, Joshua / Travers, Henry

South Dakota medicine : the journal of the South Dakota State Medical Association

2022 Volume 76, Issue 10, Page(s) 455–462

Abstract: From 1920 to 1940 in Minnehaha County there was an apparent striking increase in the incidence of fatal myocarditis and chronic myocarditis. Based on an analysis of the interment records of the Mt. Pleasant Cemetery, word frequency studies in two ... ...

Abstract	From 1920 to 1940 in Minnehaha County there was an apparent striking increase in the incidence of fatal myocarditis and chronic myocarditis. Based on an analysis of the interment records of the Mt. Pleasant Cemetery, word frequency studies in two prominent American medical journals and a general review of related medical publications, we explore this increase. We conclude that there was no actual increase in the frequency of inflammatory disorders of the myocardium in Minnehaha County during this period. Rather, it appears that the use of the diagnostic terms was a matter of choice among local physicians that was not supported by contemporaneous clinical and pathophysiologic publications in available journals.
MeSH term(s)	Humans ; United States ; Myocarditis/diagnosis ; Myocarditis/epidemiology ; South Dakota/epidemiology ; Incidence
Language	English
Publishing date	2022-10-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2278073-7
ISSN	0038-3317
ISSN	0038-3317
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