ABSTRACTS
A Statewide Evaluation of Validated EMS Clinical Trigger Tool Criteria in the Commonwealth of VirginiaAuthor: Antonio R. Fernandez, PhD, NRP | | Associate Authors: Jessica Rosner, Daisy Banta, Adam L. Harrell, Remle P. Crowe, J. Brent Myers, Alison Treichel, Scott S. Bourn
Introduction Howard et al. (2018) described a novel approach to identifying EMS adverse events by evaluating trigger tools that initiate patient care report reviews when criteria are met. These EMS-specific triggers have been assessed at the agency level but not at the state level. Objective To describe the frequency of meeting select trigger tool criteria among Virginia 9-1-1 responses in 2022. Methods This retrospective study evaluated all 9-1-1 responses with patient-treated and patient-transported dispositions submitted between January 1, 2022, and December 31, 2022, to the Commonwealth of Virginia. Triggers evaluated included: SpO2 < 94% without supplemental oxygen, SpO2 < 85% without assisted ventilation, systolic blood pressure (SBP) change > 20% from first measurement, pain score > 4/10 without subsequent reduction, temperature > 38°C without subsequent reduction, and opioid and naloxone administration in the same patient. Trigger frequency was compared by community size. Descriptive statistics, univariate odds ratio (OR), and 95% confidence intervals (95% CI) were calculated. Results A total of 735,053 9-1-1 responses were evaluated: 18% (129,218) in rural areas and 82% (605,565) in urban areas. Triggers could not be evaluated for some records due to missing vitals or lack of repeated vitals (4% [30,660] no SpO2, 17% [122,688] only one SpO2; 3% [18,824] no SBP, 15% [109,293] one SBP; 49% [361,619] no pain score, 23% [172,060] one pain score; 78% [573,489] no temperature, 20% [149,850] one temperature). Overall, at least one trigger was met for 34% (249,816) of records. The most common was the SBP trigger (15%; n = 111,603) followed by the pain score trigger (10%, n = 75,849), SpO2 < 94% trigger (10%, n = 72,592), SpO2 < 85% trigger (5%, n = 35,196), temperature trigger (0.1%, n = 1,307), and the opioid and naloxone trigger (< 0.1%, n = 51). When evaluating specific triggers, the odds of meeting the SBP trigger (OR: 1.27, 95% CI: 1.25–1.30), SpO2 < 94% trigger (OR: 1.04, 95% CI: 1.02–1.06), and SpO2 < 85% trigger (OR: 1.06, 95% CI: 1.03–1.08) were higher in rural areas. The odds of meeting the pain score trigger (OR: 0.82, 95% CI: 0.80–0.83) and the temperature trigger (OR: 0.57, 95% CI: 0.50–0.66) were lower in rural areas. Conclusion More than one-third of 9-1-1 responses in Virginia met at least one trigger tool criterion. Documentation practices should be evaluated to ensure that vital signs are appropriately recorded for relevant call types and patient presentations.
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