Reducing Disparities for Children in Rural Emergency Resuscitation (RESCU-ER)

摘要 与农村社区相比，农村地区婴儿死亡率几乎高出2倍，儿童死亡率高出2.6倍 在城市环境中；对这些儿童中的哪些部分与急救医疗互动知之甚少 服务(EMS)系统。目前农村健康差距的数据来自重要的统计数据，并表明 大部分农村超额死亡率发生在急诊医疗常见原因的条件下 服务(EMS)派单。EMS提供商提供现场响应、复苏、稳定和运输 一系列危及生命的疾病及其提供的护理是生存链中的关键一环。我们的 城市地区EMS护理研究发现，超过一半的院外儿童紧急情况 在提供护理期间发生不良安全事件(ASE)，发生率最高的是患有 心肺骤停、创伤、呼吸窘迫、癫痫发作和分娩。目前，尚不清楚是否和将 EMS护理期间发生的潜在可修改因素在多大程度上影响死亡率的差异。这 该项目建议通过以下目标解决这一知识差距：目标1：开展全面的 农村儿童生命危险结局差异的流行病学比较研究 紧急情况，以确定与改善结果和存活率有关的因素；目标2：确定和确定其特征 在EMS期间发生的AS关注并了解可修改和不可修改因素如何放大 或减弱ASES对结果的影响；目标3：测试一种新的线性认知辅助方法，以减少 并促进为儿童提供高质量的急救服务。这项研究将是一个实质性的转变 通过利用大数据方法超越高水平的结果频率和 找到通过医疗保健提供系统可以预防的问题的根源。错误被考虑在内 这是可预防的伤害和潜在死亡的重要来源。该项目的完成将导致：(1) 关于农村和城市环境中儿童死亡率和发病率以及紧急医疗服务反应的新的基于人口的研究； (2)关于农村和城市的错误如何导致可预防的发病率和死亡率的概念框架 儿童；和(3)关于线性认知辅助设备改善EMS护理和治疗安全性的试点数据 有可能缩小城乡儿童发病率和死亡率的差距。

Summary Mortality for infants is almost 2 times higher and for children 2.6 times higher in rural communities compared with urban settings; little is known about what portion of these children interact with the Emergency Medical Services (EMS) system. Data for rural health disparities currently come from vital statistics and suggest that much of the excess rural mortality occurs in conditions that are common reasons for Emergency Medical Services (EMS) dispatch. EMS providers provide scene response, resuscitation, stabilization, and transport for a range of life-threatening conditions and the care they deliver is a critical link in the chain of survival. Our research on EMS care in urban areas finds that more than half of out of hospital children's emergencies have an adverse safety event (ASE) during the delivery of care, and the highest rates are seen in children with cardiopulmonary arrest, trauma, respiratory distress, seizures, and births. Currently, it is not known if and to what extent potentially modifiable factors occurring during EMS care contribute to disparities in mortality. This project proposes to address this knowledge gap through the following aims: Aim 1: Conduct a comprehensive comparative investigation into the epidemiology of disparities in rural child outcomes from life-threatening emergencies to identify factors associated with improved outcomes & survival; Aim 2: Identify and characterize ASEs that occur during EMS care and understand how modifiable and nonmodifiable factors magnify or attenuate the effect of ASEs on outcomes; Aim 3: Test a new linear approach to cognitive aids to reduce errors and promote high-quality EMS resuscitation for children. This research will be a substantive departure from the status quo by leveraging big data approaches to move beyond high level outcome frequencies and get to the source of what might be preventable through the health care delivery system. Errors are considered an important source of preventable harm and potentially death. Completion of this project will result in: (i) a novel population-based epistry on child mortality and morbidity and EMS response in rural and urban settings; (ii) a conceptual framework of how errors contribute to preventable morbidity and mortality for rural and urban children; and (iii) pilot data on the effectiveness of linear cognitive aids to improve the safety of EMS care and potentially reduce disparities in rural and urban child morbidity and mortality.