123 Utilization Patterns by Socioeconomic Status in a Large Urban Emergency Medical Service

Research Forum Abstracts Conclusion: This study revealed that the physicians surveyed do not regularly examine the patient care report because it is not readily available. A more focused patient care report could increase the likelihood that physicians would review it. Further research is necessary to determine the specific barriers to the immediate availability of the patient care report, which could lead to improved efficiency in the ED and the entire health care system.

asthma. This out-of-hospital data supports findings from hospital studies demonstrating the need for increased primary and preventative care in low-income communities.

124

Out-of-Hospital Warming of Intravenous Saline in an Austere Environment

Gupta S, Lemery J, Musi M, Ahmed Z, Spencer C/New York Hospital Queens, Flushing, NY; Weill Cornell Medical College, New York, NY; North Shore University Hospital, Manhasset, NY

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Utilization Patterns by Socioeconomic Status in a Large Urban Emergency Medical Service

Munjal K, Goldberg S, Braun J, Freese J, Silverman R, Hall C, Kaufman B, Isaacs D, Werner A, Prezant D/Montefiore Medical Center, New York, NY; The Mount Sinai Medical Center, New York, NY; The New York City Fire Department, New York, NY; Long Island Jewish Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY

Study Objectives: Relationships between aggregate volumes of Emergency Medical Services (EMS) utilization and socioeconomic status (SES) have been previously described, most often demonstrating an inverse relationship between the 2. Epidemiologic research from emergency department or hospital records have demonstrated increased prevalence of certain medical conditions in low-income populations. In this study, we sought to describe the relationship between SES and utilization of EMS in New York City (NYC) across a spectrum of specific medical concerns, and determine if there are differences in the patterns of utilization across different SES groups. Methods: This retrospective cohort study was performed using data from the electronic Patient Care Report database from the Fire Department of the City of New York (FDNY), the municipal provider of EMS for NYC, accounting for approximately 64% of 911 EMS responses. The FDNY patient care report database was queried for all patient contacts between November, 2005 and December, 2009. The patient’s medical concerns, as well as home zip code, were extracted. Each unique patient encounter was assigned an income value as a proxy for SES by correlating the patient’s home zip code to published United States Census Bureau median income data for 2008. Patients were then divided into deciles according to the assigned income. Using this method, the relative frequency of each medical concern in each decile was tabulated. Statistical correlations between the relative frequency of each medical concern and income decile were measured using Spearman’s rank coefficients. Individual medical concerns were categorized as either medical/surgical or trauma related and similarly correlated to income decile. All data analysis was performed using the Statistical Package for the Social Sciences (SPSS) v18. Results: A total of 2,402,675 unique subject encounters were analyzed. Statistically significant negative correlations (lower SES associated with higher EMS utilization) were identified for the principal concerns of fever (-0.988), sore throat (-0.988), abdominal pain (-0.976), asthma (-0.927) and stabbings (-0.782) [all p⬍0.01]. Statistically significant positive correlations (higher SES associated with higher EMS utilization) were found for the principal concerns of syncope (0.988), motor vehicle accidents (0.988), falls (0.976), and respiratory arrest (0.939) [all p⬍0.001]. No significant trends were seen for assaults, gastrointestinal bleeds, chest pain, or allergic reactions. Overall, there was a positive correlation for all combined trauma related concerns (0.939, p⬍0.001) and a negative correlation for all combined medical/surgical concerns (-0.927, p⬍0.001). Conclusions: Using income level as a surrogate for SES, our study demonstrates very strong relationships between SES and EMS utilization among specific medical concerns. While aggregate volumes of EMS calls are known to be higher among low SES populations, not all types of medical concerns rise uniformly. The distribution of medical concerns varies considerably at different income levels, with lower income levels tending to utilize EMS in greater proportions for chronic conditions such as

Volume , .  : October 

Background: It has been published that chemical “hand warmers” can be utilized to field warm intravenous (IV) normal saline (NS) for use in the rewarming of hypothermic patients in austere environments. The warmed NS temperature should range from 37°-41° C. Study Objectives: The study objectives are to determine the maximum temperature achieved, time to maximum temperature, and efficacy of insulation in warming various sized NS bags. Methods: The study is prospective, observational and was performed outside during February, 2010/11 in downstate New York. Twelve 1 Liter, 12 500 mL, and 12 250 mL IV NS bags were cooled and divided into 4 warming groups: (1) wrapped with Grabbers (Grand Rapids, MI) 7 hour hand warmers secured by duct tape (2) wrapped with Grabbers Peel N’ Stick Adhesive body warmers (3) duct tape/hand warmers with foil blanket insulation (4) duct tape/hand warmers with Ensolite type foam insulation. The Grabbers Company reports an average warmers temperature of 57°C. Temperature measurements were taken every 5 minutes with digital metal probes (Vernier Beaverton, OR) from each IV bag. The mean temperatures of the treatment groups were calculated and the Kruskal-Wallis ANOVA on ranks was utilized for statistical analysis. Results: The study conditions were air temps -1.1 to -3.3°C with wind 5-10 mph. Starting IVF temps ranged from -2°C to 3°C. The time to temp plateau and Tmax for the 1L bags were: (1) warmers/tape 135 min & 12.43°C (2) adhesive warmer 145 minutes & 13.8°C (3) foil insulation 145 minutes & 14.33 °C (4) foam insulation 145 minutes & 17.63°C, P⬍0.001. All Pairwise Multiple Comparison Procedures (Dunn’s Method) was significant (P⬍0.05) for temp differences in foam insulation versus the other methods. The time to temp plateau and Tmax for the 500 mL bags were: (1) warmers/tape 140 min & 14.6°C (2) adhesive warmer 145 minutes & 17.77°C (3) foil insulation 160 minutes & 22.13°C (4) foam insulation 205 minutes & 23.37°C, P⫽0.002. All Pairwise Multiple Comparison Procedures (Dunn’s Method) was significant (P⬍0.05) for temp differences in foam and foil insulation versus the tape/warmers. The time to temp plateau and Tmax for the 250 mL bags were: (1) warmers/tape 175 min & 12.3°C (2) adhesive warmer 160 minutes & 17.17°C (3) foil insulation 180 minutes & 13.83 °C (4) foam insulation 175 minutes & 15.9°C, P⬍0.001. All Pairwise Multiple Comparison Procedures (Dunn’s Method) was significant (P⬍0.05) for temp differences in the adhesive warmer versus all other methods. Conclusion: Hand warmers failed to quickly or adequately warm IV NS to usable temperature for hypothermia treatment in near freezing external conditions. Insulating and heat transfer methods varied in efficacy depending on saline bag size.

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Abstract Withdrawn

Predictors of Relapse of Methicillin-Resistant Staphylococcus Aureus Bacteremia After Vancomycin Treatment

Welsh KJ, Skrobarcek KA, Abbott AN, Lewis CT, Kruzel MC, Lewis EM, Armitige LY, Wanger A/University of Texas Health Sciences Center at Houston, Houston, TX

Study Objectives: Vancomycin is the gold standard treatment for serious infections caused by methicillin-resistant S. aureus (MRSA). However, the efficacy of vancomycin is being questioned due to a number of reports of high rates of vancomycin failure frequently defined as persistent bacteremia. Few studies have specifically examined relapse of cleared bacteremia. Methods: Consecutive adult patients with MRSA bacteremia that were treated with vancomycin for greater than 5 days from 8/2005 to 5/2007 from a tertiary care hospital in Houston, Texas were identified. Recurrence of bacteremia was defined as

Annals of Emergency Medicine S219