Objectives Health insurance plans serve a critical role in public health emergencies, yet little ... more Objectives Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. Study Design A survey of health insurance plans. Methods We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Results Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend c...
Solution: Tom Minick, PeopleSoft director of CRM solutions delivery, says that a clear, multistag... more Solution: Tom Minick, PeopleSoft director of CRM solutions delivery, says that a clear, multistage specification for CRM capabilities and functionality is crucial to prevent projects from inflating out of control, pushing up costs, and delaying rollouts." The single biggest issue we see ...
Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage r... more Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage renal disease (ESRD) historically have experienced problems accessing care and adverse outcomes during disasters. Retrospective cohort study with 2 comparison groups. Using Centers for Medicare & Medicaid Services claims data, we assessed the frequency of early dialysis, emergency department (ED) visits, hospitalizations, and 30-day mortality for patients with ESRD in Sandy-affected areas (study group) and 2 comparison groups: (1) patients with ESRD living in states unaffected by Sandy during the same period and (2) patients with ESRD living in the Sandy-affected region a year prior to the hurricane (October 1, 2011, through October 30, 2011). Regional variation in dialysis care patterns and mortality for patients with ESRD in New York City and the State of New Jersey. Frequency of early dialysis, ED visits, hospitalizations, and 30-day mortality. Of 13,264 study patients, 59% received early dialysis in 70% of the New York City and New Jersey dialysis facilities. The ED visit rate was 4.1% for the study group compared with 2.6% and 1.7%, respectively, for comparison groups 1 and 2 (both P<0.001). The hospitalization rate for the study group also was significantly higher than that in either comparison group (4.5% vs 3.2% and 3.8%, respectively; P<0.001 and P<0.003). 23% of study group patients who visited the ED received dialysis in the ED compared with 9.3% and 6.3% in comparison groups 1 and 2, respectively (both P<0.001). The 30-day mortality rate for the study group was slightly higher than that for either comparison group (1.83% vs 1.47% and 1.60%, respectively; P<0.001 and P=0.1). Lack of facility level damage and disaster-induced power outage severity data. Nearly half the study group patients received early dialysis prior to Sandy's landfall. Poststorm increases in ED visits, hospitalizations, and 30-day mortality were found in the study group, but not in the comparison groups.
ABSTRACT Introduction: Academic history is a well-established predictor of educational success. P... more ABSTRACT Introduction: Academic history is a well-established predictor of educational success. Prerequisites to advanced emergency medical services (EMS) educational programs are a highly debated topic, especially in the face of possible workforce shortages. While it may be intuitive that academic history should have a bearing on success in EMS education, no empirical evidence demonstrates this relationship. Hypothesis: There is a relationship between high school class rank and first-attempt success rate on the written portion of the national paramedic certification examination. Methods: Candidates taking the National Registry of EMTs paramedic exam in 2002 were asked to report their high school class rank at the bottom of the exam answer sheet. High school class rank was correlated to first-time pass rate. Results: The paramedic written exam was administered 12,623 times during the study period, of which 8,176 were first attempts (64.8%). Of these, 5,774 (70.6%) candidates reported their high school class rank. More than half (55.9%) of the candidates taking the exam reported graduating in the top 30% of their high school classes, with only 5.5% in the lower 30%. Conclusion: There is a strong relationship between a candidate's self-reported high school class rank and the first-time pass rate on the written portion of the national certification exam. More research is needed to determine whether this relationship is causal or correlational. Chi-square = 185.63 (p ≤ 0.001).View Within Article
The didactic hours required by paramedic training programs differ tremendously throughout the cou... more The didactic hours required by paramedic training programs differ tremendously throughout the country. The authors hypothesized that a correlation exists between paramedic didactic training hours and pass/fail performance on the National Registry Examination. The authors retrospectively examined the performance of every applicant for the National Registry Paramedic Examination in June 1996. Applicants were identified by their National Registry Identification Number. A database was established linking the applicants to whether they passed or failed the NREMT-P exam. The authors then searched through the National Registry's archives and pulled each applicant's original application papers. On each application is a space to indicate the number of didactic hours of training that the particular applicant underwent. This information was also included in the database. The numbers of didactic hours of training and pass/fail performance on the NREMT-P exam were compared by point biserial correlation. One thousand six hundred applicants applied for the National Registry Examination in June 1996. For the 1,553 applicants included in the study, the mean number of didactic training hours was 377.5, with a standard deviation of 167.0 and a range of 63 to 1,594. The correlation between paramedic didactic training hours and pass/fail performance on the National Registry Examination was rpb = 0.0493, p = 0.0522. There is no correlation between paramedic didactic training hours and pass/fail performance on the NREMT-P examination.
During disasters, the public expects that emergency care will be available at a moment&am... more During disasters, the public expects that emergency care will be available at a moment's notice. As such, an emergency medical services (EMS) workforce that is trained and prepared for disasters is imperative. The primary objectives of this study were to quantify the amount of individual-level training EMS professionals receive in terrorism and disaster-preparedness, as well as to assess EMS professionals' participation in multiagency disaster drills across the United States. Characteristics of those most likely to have received individual-level training or participated in multiagency disaster drills were explored. The secondary objectives were to assess EMS professional's perception of preparedness and to determine whether the amount of training individuals received was correlated with their perceptions of preparedness. A structured survey was administered to nationally certified EMT-Basics and paramedics as part of their 2008 recertification paperwork. Outcome variables included individual-level preparedness training, participation in multiagency disaster drills, and perception of preparedness. Descriptive statistics and logistic regression modeling were used to quantify the amount of training received. Spearman rank correlation coefficients were used to analyze whether training was correlated with an individual's perception of preparedness. There were 46,127 EMS professionals who had the opportunity to complete the recertification questionnaire; 30,570 (66.3%) responded. A complete case analysis was performed on 21,438 respondents. Overall, 19,551 respondents (91.2%) reported receiving at least 1 hour of individual-level preparedness training, and 12,828 respondents (59.8%) reported participating in multiagency disaster drills, in the prior 24 months. Spearman rank correlation coefficients revealed that hours of individual-level preparedness training were significantly correlated with the perception of preparedness. While areas where EMS should focus attention for improvement were identified, a majority of nationally certified EMT-Basics and paramedics reported participating in both individual and multiagency disaster-preparedness training. A large majority of respondents reported feeling adequately prepared to respond to man-made and natural disasters and the perception of preparedness correlated with hours of training.
Objectives Health insurance plans serve a critical role in public health emergencies, yet little ... more Objectives Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. Study Design A survey of health insurance plans. Methods We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Results Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend c...
Solution: Tom Minick, PeopleSoft director of CRM solutions delivery, says that a clear, multistag... more Solution: Tom Minick, PeopleSoft director of CRM solutions delivery, says that a clear, multistage specification for CRM capabilities and functionality is crucial to prevent projects from inflating out of control, pushing up costs, and delaying rollouts." The single biggest issue we see ...
Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage r... more Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage renal disease (ESRD) historically have experienced problems accessing care and adverse outcomes during disasters. Retrospective cohort study with 2 comparison groups. Using Centers for Medicare & Medicaid Services claims data, we assessed the frequency of early dialysis, emergency department (ED) visits, hospitalizations, and 30-day mortality for patients with ESRD in Sandy-affected areas (study group) and 2 comparison groups: (1) patients with ESRD living in states unaffected by Sandy during the same period and (2) patients with ESRD living in the Sandy-affected region a year prior to the hurricane (October 1, 2011, through October 30, 2011). Regional variation in dialysis care patterns and mortality for patients with ESRD in New York City and the State of New Jersey. Frequency of early dialysis, ED visits, hospitalizations, and 30-day mortality. Of 13,264 study patients, 59% received early dialysis in 70% of the New York City and New Jersey dialysis facilities. The ED visit rate was 4.1% for the study group compared with 2.6% and 1.7%, respectively, for comparison groups 1 and 2 (both P<0.001). The hospitalization rate for the study group also was significantly higher than that in either comparison group (4.5% vs 3.2% and 3.8%, respectively; P<0.001 and P<0.003). 23% of study group patients who visited the ED received dialysis in the ED compared with 9.3% and 6.3% in comparison groups 1 and 2, respectively (both P<0.001). The 30-day mortality rate for the study group was slightly higher than that for either comparison group (1.83% vs 1.47% and 1.60%, respectively; P<0.001 and P=0.1). Lack of facility level damage and disaster-induced power outage severity data. Nearly half the study group patients received early dialysis prior to Sandy's landfall. Poststorm increases in ED visits, hospitalizations, and 30-day mortality were found in the study group, but not in the comparison groups.
ABSTRACT Introduction: Academic history is a well-established predictor of educational success. P... more ABSTRACT Introduction: Academic history is a well-established predictor of educational success. Prerequisites to advanced emergency medical services (EMS) educational programs are a highly debated topic, especially in the face of possible workforce shortages. While it may be intuitive that academic history should have a bearing on success in EMS education, no empirical evidence demonstrates this relationship. Hypothesis: There is a relationship between high school class rank and first-attempt success rate on the written portion of the national paramedic certification examination. Methods: Candidates taking the National Registry of EMTs paramedic exam in 2002 were asked to report their high school class rank at the bottom of the exam answer sheet. High school class rank was correlated to first-time pass rate. Results: The paramedic written exam was administered 12,623 times during the study period, of which 8,176 were first attempts (64.8%). Of these, 5,774 (70.6%) candidates reported their high school class rank. More than half (55.9%) of the candidates taking the exam reported graduating in the top 30% of their high school classes, with only 5.5% in the lower 30%. Conclusion: There is a strong relationship between a candidate's self-reported high school class rank and the first-time pass rate on the written portion of the national certification exam. More research is needed to determine whether this relationship is causal or correlational. Chi-square = 185.63 (p ≤ 0.001).View Within Article
The didactic hours required by paramedic training programs differ tremendously throughout the cou... more The didactic hours required by paramedic training programs differ tremendously throughout the country. The authors hypothesized that a correlation exists between paramedic didactic training hours and pass/fail performance on the National Registry Examination. The authors retrospectively examined the performance of every applicant for the National Registry Paramedic Examination in June 1996. Applicants were identified by their National Registry Identification Number. A database was established linking the applicants to whether they passed or failed the NREMT-P exam. The authors then searched through the National Registry's archives and pulled each applicant's original application papers. On each application is a space to indicate the number of didactic hours of training that the particular applicant underwent. This information was also included in the database. The numbers of didactic hours of training and pass/fail performance on the NREMT-P exam were compared by point biserial correlation. One thousand six hundred applicants applied for the National Registry Examination in June 1996. For the 1,553 applicants included in the study, the mean number of didactic training hours was 377.5, with a standard deviation of 167.0 and a range of 63 to 1,594. The correlation between paramedic didactic training hours and pass/fail performance on the National Registry Examination was rpb = 0.0493, p = 0.0522. There is no correlation between paramedic didactic training hours and pass/fail performance on the NREMT-P examination.
During disasters, the public expects that emergency care will be available at a moment&am... more During disasters, the public expects that emergency care will be available at a moment's notice. As such, an emergency medical services (EMS) workforce that is trained and prepared for disasters is imperative. The primary objectives of this study were to quantify the amount of individual-level training EMS professionals receive in terrorism and disaster-preparedness, as well as to assess EMS professionals' participation in multiagency disaster drills across the United States. Characteristics of those most likely to have received individual-level training or participated in multiagency disaster drills were explored. The secondary objectives were to assess EMS professional's perception of preparedness and to determine whether the amount of training individuals received was correlated with their perceptions of preparedness. A structured survey was administered to nationally certified EMT-Basics and paramedics as part of their 2008 recertification paperwork. Outcome variables included individual-level preparedness training, participation in multiagency disaster drills, and perception of preparedness. Descriptive statistics and logistic regression modeling were used to quantify the amount of training received. Spearman rank correlation coefficients were used to analyze whether training was correlated with an individual's perception of preparedness. There were 46,127 EMS professionals who had the opportunity to complete the recertification questionnaire; 30,570 (66.3%) responded. A complete case analysis was performed on 21,438 respondents. Overall, 19,551 respondents (91.2%) reported receiving at least 1 hour of individual-level preparedness training, and 12,828 respondents (59.8%) reported participating in multiagency disaster drills, in the prior 24 months. Spearman rank correlation coefficients revealed that hours of individual-level preparedness training were significantly correlated with the perception of preparedness. While areas where EMS should focus attention for improvement were identified, a majority of nationally certified EMT-Basics and paramedics reported participating in both individual and multiagency disaster-preparedness training. A large majority of respondents reported feeling adequately prepared to respond to man-made and natural disasters and the perception of preparedness correlated with hours of training.
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