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Article: The Effect of Prehospital Blood Transfusion on Patient Body Temperature from the Time of Emergency Medical Services Transfusion to Arrival at the Emergency Department.

Mannion, Elizabeth M / Pirrallo, Ronald G / Dix, Aaron / Estes, Luke

Journal of special operations medicine : a peer reviewed journal for SOF medical professionals

2023 Volume 23, Issue 1, Page(s) 46–53

Abstract: Background: Transfusion of blood products is life-saving and time-sensitive in the setting of acute blood-loss anemia, and is increasingly common in the emergency medical services (EMS) setting. Prehospital blood products are generally "cold-stored" at ... ...

Abstract	Background: Transfusion of blood products is life-saving and time-sensitive in the setting of acute blood-loss anemia, and is increasingly common in the emergency medical services (EMS) setting. Prehospital blood products are generally "cold-stored" at 4°C, then warmed with a portable fluid-warming system for the purpose of preventing the "lethal triad" of hypothermia, acidosis, and coagulopathy. This study aims to evaluate body temperature changes of EMS patients receiving packed red blood cells (PRBC) and/or fresh frozen plasma (FFP) when using the LifeWarmer Quantum Blood & Fluid Warming System (LifeWarmer, https://www.lifewarmer.com/). Methods: From 1 January 2020 to 31 August 2021, patients who qualified for and received PRBC and/or FFP were retrospectively reviewed. Body-temperature homeostasis pre- and post-transfusion were evaluated with attention given to those who arrived to the emergency department (ED) hypothermic (<36°C). Results: For all 69 patients analyzed, the mean initial prehospital temperature (°C) was 36.5 ± 1.0, and the mean initial ED temperature was 36.7 ± 0.6, demonstrating no statically significant change in value pre- or post-transfusion (0.2 ± 0.8, p = .09). Shock index showed a statistically significant decrease following transfusion: 1.5 ± 0.5 to 0.9 ± 0.4 (p < .001). Conclusion: Use of the Quantum prevents the previously identified risk of hypothermia with respect to unwarmed prehospital transfusions. The data is favorable in that body temperature did not decrease in critically ill patients receiving cold-stored blood warmed during administration with the Quantum.
MeSH term(s)	Humans ; Retrospective Studies ; Hypothermia/prevention & control ; Body Temperature ; Blood Transfusion ; Emergency Medical Services ; Emergency Service, Hospital
Language	English
Publishing date	2023-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	3006517-3
ISSN	1553-9768
ISSN	1553-9768
DOI	10.55460/KCZS-41KZ
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Zs.A 7196: Show issues

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Article ; Online: A data driven policy to minimise the tuberculosis testing cost among healthcare workers.

Girishan Prabhu, Vishnunarayan / Taaffe, Kevin M / Pirrallo, Ronald G / Shvorin, Dotan

The International journal of health planning and management

2022 Volume 37, Issue 5, Page(s) 2697–2709

Abstract: Introduction: The Centres for Disease Control and Prevention (CDC) mandates that healthcare employees at high-risk exposure to Tuberculosis (TB) undergo annual testing. Currently, two methods of TB testing are used: a two-step skin test (TST) or a whole- ...

Abstract	Introduction: The Centres for Disease Control and Prevention (CDC) mandates that healthcare employees at high-risk exposure to Tuberculosis (TB) undergo annual testing. Currently, two methods of TB testing are used: a two-step skin test (TST) or a whole-blood test (IGRA). Healthcare leadership's test selection must account for not only direct costs such as procedure and resources but also indirect costs, including employee workplace absence. Methods: A mathematical model based on Upstate South Carolina's largest health system affecting over 18,000 employees on six campuses was developed to investigate the value loss perspective of these testing methods and assist in decision-making. A process flow map identified the varied direct and indirect costs for each test for four employee types, and 6 travel-to-testing-site times were calculated. Results: The switching point between testing procedures that minimised total system costs was most influenced by employee salary compared to travel distance. Switching from the current hospital policy to an integrated TST/IGRA testing could reduce TB compliance costs by 28%. Conclusions: This study recommends an integrated approach as cost-effective for large health systems with multiple campuses while considering the direct and indirect costs. When accounting for 'inconvenience costs' (stress, etc.) associated with visits, IGRAs are recommended irrespective of employee salary.
MeSH term(s)	Cost-Benefit Analysis ; Health Personnel ; Humans ; Policy ; Tuberculin Test/methods ; Tuberculosis/diagnosis ; Tuberculosis/prevention & control
Language	English
Publishing date	2022-05-08
Publishing country	England
Document type	Journal Article
ZDB-ID	632786-2
ISSN	1099-1751 ; 0749-6753
ISSN (online)	1099-1751
ISSN	0749-6753
DOI	10.1002/hpm.3496
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Zs.B 2897: Show issues

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Article ; Online: A comparative analysis on fertility success among physician specialties.

Pfennig, Camiron L / Wilson, Chloe A / Britt, Thomas W / Pirrallo, Ronald G / Checura, Celina M

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2022 Volume 29, Issue 6, Page(s) 792–794

MeSH term(s)	Fertility ; Humans ; Medicine ; Physicians
Language	English
Publishing date	2022-02-27
Publishing country	United States
Document type	Letter
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14463
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Zs.A 4479: Show issues

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Article ; Online: Determinants of Persistent, Multi-Year, Frequent Emergency Department Use Among Children and Young Adults in Three US States.

Giannouchos, Theodoros V / Ukert, Benjamin / Pirrallo, Ronald G / Smith, Jeremiah / Kum, Hye-Chung / Wright, Brad / Dietrich, Ann

Academic pediatrics

2023 Volume 24, Issue 3, Page(s) 442–450

Abstract: Objective: This study examines the factors associated with persistent, multi-year, and frequent emergency department (ED) use among children and young adults.: Methods: We conducted a retrospective secondary analysis using the 2012-2017 Healthcare ... ...

Abstract	Objective: This study examines the factors associated with persistent, multi-year, and frequent emergency department (ED) use among children and young adults. Methods: We conducted a retrospective secondary analysis using the 2012-2017 Healthcare Cost and Utilization Project State Emergency Department Databases for children and young adults aged 0-19 who visited any ED in Florida, Massachusetts, and New York. We estimated the association between persistent frequent ED use and individuals' characteristics using multivariable logistic regression models. Results: Among 1.3 million patients with 1.8 million ED visits in 2012, 2.9% (37,558) exhibited frequent ED use (≥4 visits in 2012) and accounted for 10.2% (181,138) of all ED visits. Longitudinal follow-up of frequent ED users indicated that 15.4% (5770) remained frequent users periodically over the next 1 or 2 years, while 2.2% (831) exhibited persistent frequent use over the next 3-5 years. Over the 6-year study period, persistent frequent users had 31,551 ED visits at an average of 38.0 (standard deviation = 16.2) visits. Persistent frequent ED use was associated with higher intensity of ED use in 2012, public health insurance coverage, inconsistent health insurance coverage over time, residence in non-metropolitan and lower-income areas, multimorbidity, and more ED visits for less medically urgent conditions. Conclusions: Clinicians and policymakers should consider the diverse characteristics and needs of pediatric persistent frequent ED users compared to broader definitions of frequent users when designing and implementing interventions to improve health outcomes and contain ED visit costs.
MeSH term(s)	Child ; Humans ; Young Adult ; United States ; Retrospective Studies ; Emergency Service, Hospital ; Florida ; Health Care Costs ; Massachusetts
Language	English
Publishing date	2023-09-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2483385-X
ISSN	1876-2867 ; 1876-2859
ISSN (online)	1876-2867
ISSN	1876-2859
DOI	10.1016/j.acap.2023.08.021
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Zs.A 5914: Show issues

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Article ; Online: Perceived Work Demands and Emergency Department Crowding as Predictors of Objective Stress among Emergency Physicians: A Shift-Level Approach.

Britt, Thomas W / Pirrallo, Ronald G / Rosopa, Patrick J / Hirsh, Emily / Moschella, Phillip / Bessey, Alexxa / Klinefelter, Zachary / Barrows, Caroline / Reddy, Kaustubha / Faulkner, Madisen / Fowler, Lauren A

Journal of occupational and environmental medicine

2024

Abstract: Objective: To understand shift-level determinants of emergency physician (EP) burnout, relationships were tested between EP shift demands, stress, and fatigue.: Method: EP (N = 16) were assessed over 114 shifts that occurred before and during the ... ...

Abstract	Objective: To understand shift-level determinants of emergency physician (EP) burnout, relationships were tested between EP shift demands, stress, and fatigue. Method: EP (N = 16) were assessed over 114 shifts that occurred before and during the COVID-19 pandemic. Salivary cortisol (an indicator of stress) and self-reported fatigue were collected prior to and following each shift. An objective crowding score (NEDOCS) per shift was calculated. Shift demands were assessed at the end of each shift. Results: Multilevel models revealed that shift demands, NEDOCS, and the pandemic were related to higher levels of end-of-shift cortisol, but not fatigue. Cortisol levels were higher for shifts with a higher number of demands, greater crowding, and during the pandemic. Conclusions: Shift demands predicted objective indicators of stress, but not self-reported fatigue. Interventions are needed to decrease stress and shift demands to reduce EP burnout.
Language	English
Publishing date	2024-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1223932-x
ISSN	1536-5948 ; 1076-2752
ISSN (online)	1536-5948
ISSN	1076-2752
DOI	10.1097/JOM.0000000000003126
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Zs.B 155: Show issues

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Article ; Online: Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities.

Sava, M Gabriela / Pirrallo, Ronald G / Helsel, Brian C / Tian, Jingyuan / Carbajales-Dale, Patricia / Wang, Kuang-Ching / Bruch, John / Gimbel, Ronald W

The western journal of emergency medicine

2021 Volume 22, Issue 3, Page(s) 636–643

Abstract: Introduction: The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina.: Methods: We conducted this retrospective ... ...

Abstract	Introduction: The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina. Methods: We conducted this retrospective study at the largest non-profit healthcare system in South Carolina, using electronic health record (EHR) data of patients who had an ED or UC visit between February 2, 2016-July 31, 2018. Key variables including International Classification of Diseases, 10th Revision codes, laboratory test results, family history, medication, and demographic characteristics were used to classify the patients as healthy, having prediabetes, having diabetes, being at-risk for prediabetes, or being at-risk for diabetes. Patients who were known to have diabetes were classified further as having controlled diabetes, management challenged, or uncontrolled diabetes. Population analysis was stratified by the patient's annual number of ED/UC visits. Results: The risk stratification revealed 4.58% unique patients with unrecognized diabetes and 10.34% of the known patients with diabetes considered to be suboptimally controlled. Patients identified as diabetes management challenged had more ED/UC visits. Of note, 33.95% of the patients had unrecognized prediabetes/diabetes risk factors identified during their ED/UC with 87.95% having some form of healthcare insurance. Conclusion: This study supports the idea that a single ED/UC unscheduled visit can identify individuals with unrecognized diabetes and an at-risk prediabetes population using EHR data. A patient's ED/UC visit, regardless of their primary reason for seeking care, may be an opportunity to provide early identification and diabetes disease management enrollment to augment the medical care of our community.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Decision Support Techniques ; Diabetes Mellitus/classification ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/epidemiology ; Electronic Health Records/standards ; Emergency Service, Hospital/organization & administration ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Proof of Concept Study ; Retrospective Studies ; Risk Assessment ; Young Adult
Language	English
Publishing date	2021-04-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.2020.12.49171
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Article: Prehospital Antibiotics. Greenville, S.C. brings definitive sepsis care into the ambulance.

Walchok, Jason G / Lutz, Martin E / Pirrallo, Ronald G

JEMS : a journal of emergency medical services

2016 Volume 41, Issue 9, Page(s) 36–39

MeSH term(s)	Ambulances ; Anti-Bacterial Agents/therapeutic use ; Emergency Medical Services/organization & administration ; Humans ; Sepsis/diagnosis ; Sepsis/drug therapy ; South Carolina
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article
ZDB-ID	1292428-3
ISSN	0197-2510
ISSN	0197-2510
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Zs.A 4390: Show issues

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Article ; Online: Dispatcher CPR Instructions Across the Age Continuum.

Weinmeister, Kristi L / Lerner, E Brooke / Guse, Clare E / Ateyyah, Khalid A / Pirrallo, Ronald G

Prehospital and disaster medicine

2018 Volume 33, Issue 3, Page(s) 342–345

Abstract: Background: Survival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. ... ...

Abstract	Background: Survival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. Municipalities that have implemented dispatcher-assisted bystander CPR programs have seen increased rates of bystander CPR. Cardiopulmonary resuscitation instructions are given for victims of all ages, but it is unknown if offering instructions results in similar rates of EMS-documented bystander CPR across the age continuum in these municipalities. Objectives: The aim of this study was to determine if there is a difference in EMS-documented bystander CPR rates based on the age group of the OHCA victim when dispatcher CPR instructions are available in the community. Methods: This was a three-year, retrospective chart review of OHCA patients in two municipalities within a single county that provided dispatcher-assisted CPR instructions. Bystander CPR and patient age were determined based on EMS documentation. Age was stratified into three groups: child (0-12 years), adult (13-54 years), and geriatric (≥55 years). Chi square was used to compare the rate of bystander CPR in each age group. Results: During the study period, 1,993 patients were identified as being in OHCA at the time of EMS arrival. The overall bystander CPR rate was 10%. The highest rate of bystander CPR was in the child age group (19%). The lowest rate of bystander CPR was in the geriatric age group (9%). There was a statistically significant difference between age groups (P≤.01). Conclusions: The rate of EMS-documented bystander CPR was low, even though these municipalities provided dispatcher-assisted CPR instructions. The highest rates of bystander CPR were observed in children (0-12 years). Future investigations should determine why this occurs and if there are opportunities to modify dispatcher coaching based on patient age so that bystander CPR rates improve. WeinmeisterKL, LernerEB, GuseCE, AteyyahKA, PirralloRG. Dispatcher CPR instructions across the age continuum. Prehosp Disaster Med. 2018;33(3):342-345.
MeSH term(s)	Adolescent ; Adult ; Cardiopulmonary Resuscitation/methods ; Child ; Child, Preschool ; Communication ; Emergency Medical Dispatcher ; Emergency Medical Services ; Female ; Humans ; Male ; Medical Audit ; Middle Aged ; Out-of-Hospital Cardiac Arrest/therapy ; Retrospective Studies ; Teaching ; Young Adult
Language	English
Publishing date	2018-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025975-2
ISSN	1945-1938 ; 1049-023X
ISSN (online)	1945-1938
ISSN	1049-023X
DOI	10.1017/S1049023X18000377
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Zs.A 2859: Show issues

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Article ; Online: Effect of System-Wide Interventions on the Assessment and Treatment of Pain by Emergency Medical Services Providers.

Haley, Kari B / Lerner, E Brooke / Guse, Clare E / Pirrallo, Ronald G

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

2016 Volume 20, Issue 6, Page(s) 752–758

Abstract: Background: An estimated 20% of patients arriving by ambulance to the emergency department are in moderate to severe pain. However, the management of pain in the prehospital setting has been shown to be inadequate. Untreated pain may have negative ... ...

Abstract	Background: An estimated 20% of patients arriving by ambulance to the emergency department are in moderate to severe pain. However, the management of pain in the prehospital setting has been shown to be inadequate. Untreated pain may have negative physiologic and psychological consequences. The prehospital community has acknowledged this inadequacy and made treatment of pain a priority. Objectives: To determine if system-wide pain management improvement efforts (i.e. education and protocol implementation) improve the assessment of pain and treatment with opioid medications in the prehospital setting and to determine if improvements are maintained over time. Methods: This was a retrospective before and after study of a countywide prehospital patient care database. The study population included all adult patients transported by EMS between February 2004 and February 2012 with a working assessment of trauma or burn. EMS patient care records were searched for documentation of pain scores and opioid administration. Four time periods were examined: 1) before interventions, 2) after pediatric specific pain management education, 3) after pain management protocol implementation, and 4) maintenance phase. Frequencies and 95% confidence intervals were calculated for all patients meeting the inclusion criteria in each time period and Chi-square was used to compare frequencies between time periods. Results: 15,228 adult patients transported by EMS during the study period met the inclusion criteria. Subject demographics were similar between the four time periods. Pain score documentation improved between the time periods but was not maintained over time (13% [95%CI 12-15%] to 32% [95%CI 31-34%] to 29% [95 CI 27-30%] to 19% [95%CI 18-21%]). Opioid administration also improved between the time periods and was maintained over time (7% [95%CI 6-8%] to 18% [95%CI 16-19%] to 24% [95%CI 22-25%] to 23% [95% CI 22-24%]). Conclusions: In adult patients both pediatric-focused education and pain protocol implementation improved the administration of opioid pain medications. Documentation and assessment of pain scores was less affected by specific pain management improvement efforts.
Language	English
Publishing date	2016-11
Publishing country	England
Document type	Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2016.1182599
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Zs.A 4762: Show issues

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Article ; Online: A Novel Use of a Metronome in Dispatcher-assisted Cardiopulmonary Resuscitation.

Ateyyah, Khalid A / Cady, Charles E / Poltrock, James T / Pirrallo, Ronald G

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

2015 Volume 19, Issue 1, Page(s) 131–134

Abstract: Abstract Early, high-quality cardiopulmonary resuscitation (CPR) is the key to increasing the likelihood of successful resuscitation in cardiac arrest. The use of dispatch-assisted (DA) CPR can increase the likelihood of bystander CPR. We describe a case ...

Abstract	Abstract Early, high-quality cardiopulmonary resuscitation (CPR) is the key to increasing the likelihood of successful resuscitation in cardiac arrest. The use of dispatch-assisted (DA) CPR can increase the likelihood of bystander CPR. We describe a case in which a metronome was introduced to guide DA-CPR. The wife of a 52-year-old male activated 9-1-1 after her husband suffered a cardiac arrest. During her 9-1-1 call she received CPR instructions and heard a metronome over the phone while following the instructions. Return of spontaneous circulation of the patient occurred during paramedic on scene care. The patient was transported to hospital and discharged 6 days later with no neurological deficit. This case supports the use of a metronome by emergency medical dispatchers during the provision of DA-CPR to improve bystander CPR.
Language	English
Publishing date	2015-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.3109/10903127.2014.936632
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