Hypoglycemia
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Bounce back
|
Patient
|
PH-Paramedic
|
Anderson S., Hogskilde PD., Wetterslev J., et al. Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: A retrospective study. Acta Anaesthesiol Scand 2002; 46(4):464-8. Medline
|
II
|
Supportive (Green)
|
Repeat ambulance call, recurrence of hypoglycemia
|
Process
|
PH-Paramedic
|
Cain E., Ackroyd-Stolarz S., Alexiadia P., Murray D. Prehospital hypoglycemia: the safety of not transporting treated patients. Prehospital Emergency Care 2003; 7:458-65. Medline
|
II
|
Supportive (Green)
|
Relapse within 3 days
|
Process
|
PH-Paramedic
|
Carter AJ., Keane PS., Dreyer JF. Transport refusal by hypoglycemic patients after on-scene intravenous dextrose. Acad Emerg Med 2002; 9(8):855-7. Medline
|
II
|
Supportive (Green)
|
Relapse
|
Patient
|
PH-Paramedic
|
Socransky SJ., Pirrallo RG., Rubin JM. Out-of-hospital treatment of hypoglycemia: Refusal of transport and patient outcome. Acad Emerg Med 1998; 5(11):1080-1085. Medline
|
III
|
Supportive (Green)
|
Transport to hospital
|
Patient
|
PH-Paramedic
|
Khunti K., Fisher H., Paul S., Iqbal M., Davies MJ., Siriwardena AN. Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: A retrospective study. Prim Care Diabetes 2013; 7(2):159-65. Medline
|
III
|
Supportive (Green)
|
Safety
|
Process
|
PH-Paramedic
|
Lerner EB., Billittier AJ 4th., Lance DR., Janicke DM., Teuscher JA. Can paramedics safely treat and discharge hypoglycemic patients in the field? Am J Emerg Med 2003; 21(2):115-20. Medline
|
III
|
Supportive (Green)
|
Efficacy
|
Patient
|
PH-Paramedic
|
Mattila Elina M., Kuisma Markku J., Sund Kaj P., Voipio-Pulkki. Out-of-hospital hypoglycaemia is safely and cost-effectively treated by paramedics. European Journal of Emergency Medicine 2004; 11(2):70-4. Medline
|
III
|
Supportive (Green)
|
Recurrence of symptoms
|
Patient
|
PH-Paramedic
|
Mechem CC., Kreshak AA., Barger J., Shofer FS. The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out of hospital therapy. Acad Emerg Med 1998; 5(8):768-72. Medline
|
III
|
Supportive (Green)
|
Patient preference
|
Patient
|
PH-Paramedic
|
Steinmetz J., Nielsen SL., Rasmussen LS. Hypoglycaemia in patients with diabetes: do they prefer prehospital treatment or admission to hospital? Eur J Emerg Med 2006; 13(5):319-320. Medline
|
III
|
Supportive (Green)
|
Triage
|
Process
|
PH-Paramedic
|
Strote J., Simmons R., Eisenberg M. EMT treatment of hypoglycemia without transport. Am J Emerg Med 2008; 26:291-5. Medline
|
III
|
Supportive (Green)
|
Success
|
Patient
|
PH-Paramedic
|
Weston C., Stephens M. Hypoglycemic attacks treated by ambulance personnel with extended training. Br Med J 1990; 300:908-909. Medline
|
III
|
Neutral (Yellow)
|
Risk of repeat hypoglycemic events
|
Patient
|
PH-Paramedic
|
Fitzpatrick D., Duncan EA. Improving post-hypoglycaemic patient safety in the prehospital environment: A systematic review. Emerg Med J 2009; 26(7):472-8. Medline
|
Opioid overdose
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
48 hour mortality
|
Patient
|
ED-Paramedic & MD
|
Greene JA, Deveau BJ, Dol JS, Butler MB.Incidence of mortality due to rebound toxicity after 'treat and release' practices in prehospital opioid overdose care: a systematic review. Emerg Med J 2019; 36(4):219-224. Medline
|
II
|
Neutral (Yellow)
|
Efficacy
|
Patient
|
PH-Paramedic
|
Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O'Reilly C, et al. Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review. Ann Intern Med 2017; 167(12) 867-75. Medline
|
II
|
Neutral (Yellow)
|
One-week mortality after pre-hospital discharge
|
Patient
|
PH-Paramedic
|
Heyerdahl F., Hovda KE., Bjornaas MA., Nore AK., Figueiredo JC., Ekeberg O., Jacobsen D. Pre-hospital treatment of acute poisonings in oslo. BMC Emergency Medicine 2008; 8:15-227X-8-15. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Process
|
PH-Paramedic
|
McLeod KE, Slaunwhite AK, Zhao B, Moe J, Purssell R, Gan W, et al. Comparing mortality and healthcare utilization in the year following a paramedic-attended non-fatal overdose among people who were and were not transported to hospital: A prospective cohort study using linked administrative health data. Drug Alcohol Depend 2020:108381. Medline
|
II
|
Neutral (Yellow)
|
Relapse risk
|
Patient
|
PH-Paramedic
|
Zozula A, Neth MR, Hogan AN, Stolz U, McMullan J. Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose. Prehosp Emerg Care 2021:1-11. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Boyd JJ., Kuisma MJ., Alaspaa AO., Vuori E., Repo JV., Randell TT. Recurrent opioid toxicity after pre-hospital care of presumed heroin overdose patients. Acta Anaesthesiol Scand 2006; 50: 1266-70. Medline
|
III
|
Supportive (Green)
|
Safety
|
Patient
|
PH-Paramedic
|
Levine M., Sanko S., Eckstein M. Assessing the risk of prehospital administration of naloxone with subsequent refusal of care. Prehosp Emerg Care 2016; 20:566–9. Medline
|
III
|
Supportive (Green)
|
Death and/or readmission
|
Patient
|
PH-Paramedic
|
Seidler D., Stuhlinger GH., Fischer G., et al. After antagonization of acute opiate overdose: A survey at hospitals in Vienna. Addiction 1996; 91(10):1479-1487. Medline
|
III
|
Supportive (Green)
|
Safety
|
Process
|
PH-Paramedic
|
Vilke G., Buhanan J., Dunford J., Chan T. Are Heroin Overdose Deaths Related to Patient Release After Prehospital Treatment with Naloxone? Prehospital Emergency Care 1999; 3(3):183-186. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Vilke GM., Sloane C., Smith AM., Chan TC. Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2003; 10(8):893-896. Medline
|
III
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Wampler DA., Molina DK., McManus J., Laws P., Manifold CA. No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose. Prehosp Emerg Care 2011; 15(3):320-324. Medline
|
III
|
Neutral (Yellow)
|
Adverse Event
|
Patient
|
ED-MD
|
Christenson J., Etherington J., Grafstein E., et al. Early discharge of patients with presumed opioid overdose: Development of a clinical prediction rule. Acad Emerg Med 2000; 7(10):1110-8. Medline
|
III
|
Neutral (Yellow)
|
Rebound toxicity
|
Patient
|
PH-Paramedic
|
Rudolph SS., Jehu G., Nielsen SL., Nielsen K., Siersma V., Rasmussen LS. Prehospital treatment of opioid overdose in copenhagen--is it safe to discharge on-scene? Resuscitation 2011; 82(11):1414-8. Medline
|