Daniel W Spaite

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Scholarly Contributions

Books

• Galli, R. L., Spaite, D. W., & Simon, R. R. (1989). Emergency orthopedics : the spine. Appleton & Lange.

Journals/Publications

• Gaither, J., Spaite, D., Bobrow, B., Barnhart, B., Chikani, V., Denninghoff, K., Bradley, G., Rice, A., Howard, J., Keim, S., & Hu, C. (2024). EMS Treatment Guidelines in Major Traumatic Brain Injury with Positive Pressure Ventilation. JAMA Surgery, 159(4). doi:10.1001/jamasurg.2023.7155
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  Importance: The Excellence in Prehospital Injury Care (EPIC) study demonstrated improved survival in patients with severe traumatic brain injury (TBI) following implementation of the prehospital treatment guidelines. The impact of implementing these guidelines in the subgroup of patients who received positive pressure ventilation (PPV) is unknown. Objective: To evaluate the association of implementation of prehospital TBI evidence-based guidelines with survival among patients with prehospital PPV. Design, Setting, and Participants: The EPIC study was a multisystem, intention-to-treat study using a before/after controlled design. Evidence-based guidelines were implemented by emergency medical service agencies across Arizona. This subanalysis was planned a priori and included participants who received prehospital PPV. Outcomes were compared between the preimplementation and postimplementation cohorts using logistic regression, stratified by predetermined TBI severity categories (moderate, severe, or critical). Data were collected from January 2007 to June 2017, and data were analyzed from January to February 2023. Exposure: Implementation of the evidence-based guidelines for the prehospital care of patient with TBI. Main Outcomes and Measures: The primary outcome was survival to hospital discharge, and the secondary outcome was survival to admission. Results: Among the 21852 participants in the main study, 5022 received prehospital PPV (preimplementation, 3531 participants; postimplementation, 1491 participants). Of 5022 included participants, 3720 (74.1%) were male, and the median (IQR) age was 36 (22-54) years. Across all severities combined, survival to admission improved (adjusted odds ratio [aOR], 1.59; 95% CI, 1.28-1.97), while survival to discharge did not (aOR, 0.94; 95% CI, 0.78-1.13). Within the cohort with severe TBI but not in the moderate or critical subgroups, survival to hospital admission increased (aOR, 6.44; 95% CI, 2.39-22.00), as did survival to discharge (aOR, 3.52; 95% CI, 1.96-6.34). Conclusions and Relevance: Among patients with severe TBI who received active airway interventions in the field, guideline implementation was independently associated with improved survival to hospital admission and discharge. This was true whether they received basic airway interventions or advanced airways. These findings support the current guideline recommendations for aggressive prevention/correction of hypoxia and hyperventilation in patients with severe TBI, regardless of which airway type is used..
• Karra, R., Rice, A., Hardcastle, A., Lara, J., Hollen, A., Glenn, M., Munn, R., Hannan, P., Arcaris, B., Derksen, D., Spaite, D., & Gaither, J. (2024). Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System. Western Journal of Emergency Medicine, 25(5). doi:10.5811/westjem.18427
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  Background: Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers. Methods: This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months post-implementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality. Results: The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019–September 10, 2020) and the post-implementation period (September 11, 2020–December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45–2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (P = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as “good.” Conclusion: In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as “good.”
• Wang, H., Hu, C., Barnhart, B., Jansen, J., & Spaite, D. W. (2024).

  Changes in Neurologic Status after Traumatic Brain Injury In the Resuscitation Outcomes Consortium Hypertonic Saline Trial

  . JACEP Open, 5:e13107 (Mar 18). doi:10.1002/emp2.13107
• Barnhart, B. J., Spaite, D. W., Jorgenson, D. B., Burgett, K. S., Adam, S., Rice, A. D., Gaither, J. B., Keim, S. M., & Hu, C. (2023). Abstract 252: End-Tidal CO2 and Glasgow Coma Scale in Non-Intubated Traumatic Brain Injury Patients: Evaluation of Prehospital Nasal Capnography and Level of Consciousness. Circulation, 148(Suppl_1). doi:10.1161/circ.148.suppl_1.252
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  Background: The EMS traumatic brain injury (TBI) guidelines recommend limiting intubation (ETI) to patients with profoundly-depressed level of consciousness (LOC) and who cannot protect their airway or adequately ventilate with basic maneuvers. Thus, many major TBIs are managed without ETI in the field. Monitoring ETCO2 via nasal sensors (NC-CO2) in non-ETI patients may provide valuable information about ventilatory status and trends. However, EMS NC-CO2 remains unstudied. Objective: To evaluate the association between LOC and NC-CO2 in non-intubated TBI. Methods: Cases from 7 EMS agencies reporting continuous monitor data (Philips MRx™) in the EPIC TBI Study (NIH 1R01NS071049) were evaluated (4/13-4/18). Comparisons in patient-level mean, median, lowest and highest NC-CO2 levels were made across GCS categories using clinically meaningful thresholds:
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Burgett, K., Seiver, A., Rice, A. D., Gaither, J. B., Keim, S. M., & Hu, C. (2023). 76 End-Tidal CO2 and Glasgow Coma Scale in Non-Intubated Traumatic Brain Injury: Evaluation of Prehospital Nasal Capnography and Level of Consciousness. Prehospital Emergency Care. doi:10.1016/s0300-9572(23)00419-7
• Gaither, J. B., Rice, A., Jado, I., Armstrong, S., Packard, S. E., Clark, J., Draper, S., Duncan, M., Bradley, B., & Spaite, D. W. (2023). Impact of In-Station Medication Automated Dispensing Systems On Prehospital Pain Medication Administration. Prehosp Emerg Care, 27(3), 350-355. doi:10.1080/10903127.2022.2045405
• Rice, A. D., Hu, C., Spaite, D. W., Barnhart, B. J., Chikani, V., Gaither, J. B., Denninghoff, K. R., Bradley, G. H., Howard, J. T., Keim, S. M., & Bobrow, B. J. (2023). Correlation between prehospital and in-hospital hypotension and outcomes after traumatic brain injury. The American journal of emergency medicine, 65, 95-103. doi:10.1016/j.ajem.2022.12.015
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  Hypotension has a powerful effect on patient outcome after traumatic brain injury (TBI). The relative impact of hypotension occurring in the field versus during early hospital resuscitation is unknown. We evaluated the association between hypotension and mortality and non-mortality outcomes in four cohorts defined by where the hypotension occurred [neither prehospital nor hospital, prehospital only, hospital only, both prehospital and hospital].
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Seiver, A., Helfenbein, E., Gaither, J. B., Rice, A. D., Keim, S. M., & Hu, C. (2022). Abstract 167: Nasal Sensor Capnographic Differences In Major Traumatic Brain Injury Patients Receiving Non-rebreather Mask Versus Nasal Cannula Oxygen Delivery. Prehospital Emergency Care. doi:10.1161/circ.146.suppl_1.167
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  Background: The advent of highly sensitive End-Tidal CO2 (ETCO2) sensors allows effective monitoring of intubated patients in EMS. Previous work has explored the use of ETCO2 monitoring in non-intubated patients with sensors placed in the nares. However, little is known about the effect of passive O2 delivery [nasal cannula (NC) or high-flow, non-rebreather mask (NRB)] on ETCO2 measurement. Objective: To compare ETCO2 measurements in non-intubated Traumatic Brain Injury (TBI) patients receiving O2 via NC vs. NRB in the field. Methods: A subset of cases from the EPIC EMS TBI Study (NIH-1R01NS071049) were evaluated (4/13-4/18). Non-intubated cases from 5 EMS agencies providing monitor data, including continuous ETCO2. Start and end segments were excluded to remove artifact from initiation (“ramp-up”) or termination of monitoring. Statistics: Wilcoxon rank-sum test, two-sample t-test, and Chi-squared test were used as appropriate. Linear regression compared continuous variables in adjusted analyses (α = 0.05). Results: Included were 151 cases [median age: 52 (range: 9-91; 66% male)]. Of those, 62 (41%) received NCO2 and 89 (59%) via NRB. Patient-level mean ETCO2 was slightly lower in the NC group (mean = 26.9 mmHg; SD 6.7) compared to NRB (mean 30.2; SD 8.1; p=0.007). Differences in the mean were: Unadjusted: 3.3 (95% CI 0.9-5.7); Adjusted 2.7 (0.2-5.2). There were no significant differences in means of the patient-level lowest or highest recorded values. Conclusion: While there was a statistically lower ETCO2 in the NC versus NRB-oxygenated patients, it was around 3 mmHg and, thus, not clinically significant. This is surprising since: 1) the O2 flow rates and 2) the open-air (NC) versus mask (NRB) delivery methods are so dramatically different. Future study is needed to identify the clinical implications of using noninvasive ETCO2 measurement as a tool for monitoring ventilatory status and changes in non-intubated TBI (and other) patients in emergency settings.
• Gaither, J. B., Rice, A. D., Jado, I., Armstrong, S., Packard, S. E., Clark, J., Draper, S., Duncan, M., Bradley, B., & Spaite, D. W. (2022). Impact of in-Station Medication Automated Dispensing Systems on Prehospital Pain Medication Administration. Prehospital Emergency Care, 1-6. doi:10.1080/10903127.2022.2045405
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  Gaither JB, Rice AD, Jado I, Armstrong S, Packard SE, Clark J, Draper S, Duncan M, Bradley B, Spaite DW. Impact of In-Station Medication Automated Dispensing Systems On Prehospital Pain Medication Administration
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Rice, A. D., Chikani, V., Denninghoff, K. R., Bradley, G. H., Howard, J. T., & Keim, S. M. (2022). Abstract 168: Hypoxia On Arrival At The Hospital Among Major Traumatic Brain Injury Patients Who Were Non-Hypoxic In The Field: Support For “Hyper-oxic” Prehospital Treatment?. Circulation, 146(Suppl_1). doi:10.1161/circ.146.suppl_1.168
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  Background: Prehospital and early hospital hypoxia powerfully affect traumatic brain injury (TBI) outcomes. However, the correlations between EMS and hospital O2 saturations are unknown. Using the EPIC Study data (NIH-1R01NS071049; DOD-W81XWH-19-C-0058), we assessed correlations between EMS SpO2 and the risk of major TBI patients arriving at the trauma center (TC) with hypoxia (initial ED SpO2
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B., Chikani, V., Gaither, J. B., Denninghoff, K. R., Bradley, G. H., Rice, A. D., Howard, J. T., & Keim, S. M. (2022). Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Annals of emergency medicine, 80(1), 46-59. doi:10.1016/j.annemergmed.2022.01.045
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  Little is known about the out-of-hospital blood pressure ranges associated with optimal outcomes in traumatic brain injuries (TBI). Our objective was to evaluate the associations between out-of-hospital systolic blood pressure (SBP) and multiple hospital outcomes without assuming any predefined thresholds for hypotension, normotension, or hypertension..This was a preplanned secondary analysis from the Excellence in Prehospital Injury Care (EPIC) TBI study. Among patients (age ≥10 years) with major TBIs (Barell Matrix type 1 and/or Abbreviated Injury Scale-head severity ≥3) and lowest out-of-hospital SBPs of 40 to 299 mmHg, we utilized generalized additive models to summarize the distributions of various outcomes as smoothed functions of SBP, adjusting for important and significant confounders. The subjects who were enrolled in the study phase after the out-of-hospital TBI guideline implementation were used to validate the models developed from the preimplementation cohort..Among 12,169 included cases, the mortality model revealed 3 distinct ranges: (1) a monotonically decreasing relationship between SBP and the adjusted probability of death from 40 to 130 mmHg, (2) lowest adjusted mortality from 130 to 180 mmHg, and (3) rapidly increasing mortality above 180 mmHg. A subanalysis of the cohorts with isolated TBIs and multisystem injuries with TBIs revealed SBP mortality patterns that were similar to each other and to that of the main analysis. While the specific SBP ranges varied somewhat for the nonmortality outcomes (hospital length of stay, ICU length of stay, discharge to skilled nursing/inpatient rehabilitation, and hospital charges), the patterns were very similar to that of mortality. In each model, validation was confirmed utilizing the postimplementation cohort..Optimal adjusted mortality was associated with a surprisingly high SBP range (130 to 180 mmHg). Below this level, there was no point or range of inflection that would indicate a physiologically meaningful threshold for defining hypotension. Nonmortality outcomes showed very similar patterns. These findings highlight how sensitive the injured brain is to compromised perfusion at SBP levels that, heretofore, have been considered adequate or even normal. While the study design does did not allow us to conclude that the currently recommended treatment threshold (
• Stiell, I. G., Maloney, J., Dreyer, J., Munkley, D., Spaite, D. W., Lyver, M. B., Sinclair, J. E., & Wells, G. A. (2022). Advanced Life Support for Out-Of-Hospital Chest Pain: The OPALS Study. Prehospital Emergency Care, 26, 428-436. doi:10.1080/10903127.2022.2045407
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  The addition of a prehospital advanced life support program to an existing basic life support emergency medical service was associated with a significant decrease in the mortality rate among patients complaining of chest pain. 
• Stiell, I. G., Maloney, J., Dreyer, J., Munkley, D., Spaite, D. W., Lyver, M. B., Sinclair, J. E., Wells, G., & AUTHOR_ID, N. (2022). Advanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study^†. Annals of Emergency Medicine. doi:10.1080/10903127.2022.2045407
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  Context: As many as 14% of patients transported by ambulance with chest pain die prior to hospital discharge. To date, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect survival for these patients. Objective: The Ontario Prehospital Advanced Life Support (OPALS) Study assessed the effect of adding an advance life support service to an existing basic life support emergency medical service program, on the rate of mortality and morbidity for patients with out-of-hospital chest pain. Design: Controlled clinical trial comparing survival for 9 months before and 9 after instituting an advanced life support program. Setting: Thirteen urban and suburban Ontario communities (populations ranging from 30,000 to 750,000; total, 2.5 million). Patients: All adult patients with a primary complaint of chest pain and transported by paramedics to the emergency department. Intervention: Paramedics were trained in standard advanced life support, which includes endotracheal intubation, intravenous furosemide and morphine, oral ASA, and sublingual NTG. Emergency medical services within each community had to meet predefined criteria in order to qualify for the advanced life support phase. Main Outcome Measure: Survival to hospital discharge. Results: Overall, 12,168 patients were enrolled in either the basic life support phase (N = 5,788) or the advanced life support phase (N = 6,380). The rate of mortality significantly decreased from 4.3% in the basic life support phase to 3.2% in the advanced life support phase (absolute change 1.1, 95% CI 0.4-1.8, P = 0.0013). We also demonstrated a decrease in mortality for the subgroup of patients with a discharge diagnosis of myocardial infarction (13.1 percent vs 8.2 percent, P = 0.002). Conclusions: The addition of a prehospital advanced life support program to an existing basic life support emergency medical service was associated with a significant decrease in the mortality rate among patients complaining of chest pain. Future research should clarify the most effective interventions and target specific populations.
• Stiell, I., Maloney, J., Dreyer, J., Munkley, D., Spaite, D., Lyver, M., Sinclair, J., & Wells, G. (2022). Advanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study†. Prehospital Emergency Care, 26(3). doi:10.1080/10903127.2022.2045407
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  Context: As many as 14% of patients transported by ambulance with chest pain die prior to hospital discharge. To date, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect survival for these patients. Objective: The Ontario Prehospital Advanced Life Support (OPALS) Study assessed the effect of adding an advance life support service to an existing basic life support emergency medical service program, on the rate of mortality and morbidity for patients with out-of-hospital chest pain. Design: Controlled clinical trial comparing survival for 9 months before and 9 after instituting an advanced life support program. Setting: Thirteen urban and suburban Ontario communities (populations ranging from 30,000 to 750,000; total, 2.5 million). Patients: All adult patients with a primary complaint of chest pain and transported by paramedics to the emergency department. Intervention: Paramedics were trained in standard advanced life support, which includes endotracheal intubation, intravenous furosemide and morphine, oral ASA, and sublingual NTG. Emergency medical services within each community had to meet predefined criteria in order to qualify for the advanced life support phase. Main Outcome Measure: Survival to hospital discharge. Results: Overall, 12,168 patients were enrolled in either the basic life support phase (N = 5,788) or the advanced life support phase (N = 6,380). The rate of mortality significantly decreased from 4.3% in the basic life support phase to 3.2% in the advanced life support phase (absolute change 1.1, 95% CI 0.4-1.8, P = 0.0013). We also demonstrated a decrease in mortality for the subgroup of patients with a discharge diagnosis of myocardial infarction (13.1 percent vs 8.2 percent, P = 0.002). Conclusions: The addition of a prehospital advanced life support program to an existing basic life support emergency medical service was associated with a significant decrease in the mortality rate among patients complaining of chest pain. Future research should clarify the most effective interventions and target specific populations.
• Wang, H. E., Hu, C., Barnhart, B. J., Jansen, J. O., & Spaite, D. W. (2022). Abstract 226: Long-term Trajectory Of Neurologic Outcome After Severe Traumatic Brain Injury. Prehospital Emergency Care. doi:10.1161/circ.146.suppl_1.226
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  Objective : Little is known about the time-based trajectories of neurologic recovery after traumatic brain injury (TBI). We sought to determine long-term changes in neurologic status after TBI. Methods: Data source: Resuscitation Outcomes Consortium Hypertonic Saline TBI Trial. Included: adult TBI, GCS≤8; Excluded: shock (SBP≤70, or SBP 71-90 with HR≥108). Primary outcome: Glasgow Outcome Scale-Extended (GOS-E; 1=dead, 8=no disability) determined at: a) hospital discharge and b) 6-months. We analyzed changes in GOS-E between hospital discharge and 6-months using Sankey graphs and the Wilcoxon signed-rank test. We repeated the analysis for the high acuity subset of patients undergoing EMS advanced airway insertion. Results: Among 1,282 TBI, GOS-E at discharge was: dead (GOS-E 1) n=321 (25.0%), unfavorable (2-4) n=664 (51.8%), favorable (5-8) n=220 (17.2%), missing n=77 (6.0%; Figure). GOS-E at 6-months was: dead n=346 (27.0%), unfavorable n=282 (22.0%), favorable n=459 (35.8%), missing n=195 (15.2%). While 7 of 220 (3.2%) with favorable GOS-E at discharge worsened at 6 months (unfavorable or died), 300 of 664 (45.2%) with unfavorable GOS-E improved to favorable at 6 months (Wilcoxon signed-rank for GOS-E change p
• Arcaris, B., Gaither, J. B., Glenn, M. J., Hannan, P., Hollen, A., Jado, I., Mcdonough, S., Primeau, K., Rice, A. D., & Spaite, D. W. (2021). Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 25(1), 46-54. doi:10.1080/10903127.2020.1834656
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  To determine if COVID-19 was associated with a change in patient refusals after Emergency Medical Services (EMS) administration of naloxone..This is a retrospective cohort study in which the incidence of refusals after naloxone administration in a single EMS system was evaluated. The number of refusals after naloxone administration was compared across the before-pandemic interval (01/01/20 to 02/15/20) and the during-pandemic interval (03/16/20 to 04/30/20). For comparison the incidence of all other patient refusals before and during COVID-19 as well as the incidences of naloxone administration before and during COVID-19 were also reported..Prior to the widespread knowledge of the COVID-19 pandemic, 24 of 164 (14.6%) patients who received naloxone via EMS refused transport. During the pandemic, 55 of 153 (35.9%) patients who received naloxone via EMS refused transport. Subjects receiving naloxone during the COVID-19 pandemic were at greater risk of refusal of transport than those receiving naloxone prior to the pandemic (RR = 2.45; 95% CI 1.6-3.76). Among those who did not receive naloxone, 2067 of 6956 (29.7%) patients were not transported prior to the COVID-19 pandemic and 2483 of 6016 (41.3%) were not transported during the pandemic. Subjects who did not receive naloxone with EMS were at greater risk of refusal of transport during the COVID-19 pandemic than prior to it (RR = 1.39; 95% CI 1.32-1.46)..In this single EMS system, more than a two-fold increase in the rate of refusal after non-fatal opioid overdose was observed following the COVID-19 outbreak.
• Gaither, J. B., Gaither, J. B., Spaite, D. W., Spaite, D. W., Bobrow, B. J., Bobrow, B. J., Keim, S. M., Keim, S. M., Barnhart, B. J., Barnhart, B. J., Chikani, V., Chikani, V., Sherrill, D., Sherrill, D., Denninghoff, K. R., Denninghoff, K. R., Mullins, T., Mullins, T., Adelson, P. D., , Adelson, P. D., et al. (2021). Impact of Implementing the Prehospital Traumatic Brain Injury Treatment Guidelines: The Excellence In Prehospital Injury Care for Children (EPIC4Kids) Study. Annals of emergency medicine, 77(2), 139-153. doi:10.1016/j.annemergmed.2020.09.435
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  We evaluate the effect of implementing the out-of-hospital pediatric traumatic brain injury guidelines on outcomes in children with major traumatic brain injury. Gaither JB, Spaite DW, Bobrow BJ, Keim SM, Barnhart BJ, Chikani V, Sherrill D, Denninghoff KR, Mullins T, Adelson PD, Rice AD, Viscusi C, Hu C: Impact of Implementing the Prehospital Traumatic Brain Injury Treatment Guidelines: The Excellence In Prehospital Injury Care for Children (EPIC4Kids) Study. Ann Emerg Med. 2021:77(2):139-153. DOI: 10.1016/j.annemergmed.2020.09.435. Epub 2020 November 11. NIH Manuscript System ID: NIHMSID:1654418; PubMed PMID:33187749
• Gaither, J., Spaite, D., Bobrow, B., Keim, S., Barnhart, B., Chikani, V., Sherrill, D., Denninghoff, K., Mullins, T., Adelson, P., Rice, A., Viscusi, C., & Hu, C. (2021). Effect of Implementing the Out-of-Hospital Traumatic Brain Injury Treatment Guidelines: The Excellence in Prehospital Injury Care for Children Study (EPIC4Kids). Annals of Emergency Medicine, 77(2). doi:10.1016/j.annemergmed.2020.09.435
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  Study objective: We evaluate the effect of implementing the out-of-hospital pediatric traumatic brain injury guidelines on outcomes in children with major traumatic brain injury. Methods: The Excellence in Prehospital Injury Care for Children study is the preplanned secondary analysis of the Excellence in Prehospital Injury Care study, a multisystem, intention-to-treat study using a before-after controlled design. This subanalysis included children younger than 18 years who were transported to Level I trauma centers by participating out-of-hospital agencies between January 1, 2007, and June 30, 2015, throughout Arizona. The primary and secondary outcomes were survival to hospital discharge or admission for children with major traumatic brain injury and in 3 subgroups, defined a priori as those with moderate, severe, and critical traumatic brain injury. Outcomes in the preimplementation and postimplementation cohorts were compared with logistic regression, adjusting for risk factors and confounders. Results: There were 2,801 subjects, 2,041 in preimplementation and 760 in postimplementation. The primary analysis (postimplementation versus preimplementation) yielded an adjusted odds ratio of 1.16 (95% confidence interval 0.70 to 1.92) for survival to hospital discharge and 2.41 (95% confidence interval 1.17 to 5.21) for survival to hospital admission. In the severe traumatic brain injury cohort (Regional Severity Score–Head 3 or 4), but not the moderate or critical subgroups, survival to discharge significantly improved after guideline implementation (adjusted odds ratio = 8.42; 95% confidence interval 1.01 to 100+). The improvement in survival to discharge among patients with severe traumatic brain injury who received positive-pressure ventilation did not reach significance (adjusted odds ratio = 9.13; 95% confidence interval 0.79 to 100+). Conclusion: Implementation of the pediatric out-of-hospital traumatic brain injury guidelines was not associated with improved survival when the entire spectrum of severity was analyzed as a whole (moderate, severe, and critical). However, both adjusted survival to hospital admission and discharge improved in children with severe traumatic brain injury, indicating a potential severity-based interventional opportunity for guideline effectiveness. These findings support the widespread implementation of the out-of-hospital pediatric traumatic brain injury guidelines.
• Glenn, M., Rice, A., Primeau, K., Hollen, A., Jado, I., Hannan, P., McDonough, S., Arcaris, B., Spaite, D. W., & Gaither, J. B. (2021). Refusals after prehospital administration of naloxone during the COVID-19 pandemic. Prehospital Emergency Care, 25(1), 46-54. doi:10.1080/10903127.2020.1834656
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  Glenn MJ, Rice AD, Primeau K, Hollen A, Jado I, Hannan P, McDonough S, Arcaris B, Spaite DW, Gaither JB: Refusals after prehospital administration of naloxone during the COVID-19 pandemic. Prehosp Emerg Care. 2020. Epub 2020 November 3. DOI: 10.1080/10903127.2020.1834656. PubMed PMID: 33054530
• Hu, C., Keim, S. M., Gaither, J. B., Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., & Rice, A. D. (2021). Abstract 13737: Enhanced Prehospital End-Tidal CO2 Monitor Data Analysis for Intubated Severe Traumatic Brain Injury: Striking Findings From the EPIC Study. Circulation, 144(Suppl_2). doi:10.1161/circ.144.suppl_2.13737
• Cone, D. C., Spaite, D. W., & Coats, T. J. (2020). Out-of-Hospital Tranexamic Acid for Traumatic Brain Injury. JAMA, 324(10), 946-947.
• Gaither, J. B., Spaite, D. W., Arcaris, B., McDonough, S., Hannan, P., Jado, I., Hollen, A., Primeau, K., Rice, A., & Glenn, M. (2020). Refusals after prehospital administration of naloxone during the COVID-19 pandemic. Prehospital Emergency Care. doi:10.1080/10903127.2020.1834656
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  Glenn MJ, Rice AD, Primeau K, Hollen A, Jado I, Hannan P, McDonough S, Arcaris B, Spaite DW, Gaither JB: Refusals after prehospital administration of naloxone during the COVID-19 pandemic. Prehosp Emerg Care. 2020. Epub 2020 November 3. DOI: 10.1080/10903127.2020.1834656. PubMed PMID: 33054530
• Glenn, M., Rice, A., Primeau, K., Hollen, A., Jado, I., Hannan, P., McDonough, S., Arcaris, B., Spaite, D., & Gaither, J. (2020). Refusals After Prehospital Administration of Naloxone during the COVID-19 Pandemic. Prehospital Emergency Care, 25(1). doi:10.1080/10903127.2020.1834656
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  Objective: To determine if COVID-19 was associated with a change in patient refusals after Emergency Medical Services (EMS) administration of naloxone. Methods: This is a retrospective cohort study in which the incidence of refusals after naloxone administration in a single EMS system was evaluated. The number of refusals after naloxone administration was compared across the before-pandemic interval (01/01/20 to 02/15/20) and the during-pandemic interval (03/16/20 to 04/30/20). For comparison the incidence of all other patient refusals before and during COVID-19 as well as the incidences of naloxone administration before and during COVID-19 were also reported. Results: Prior to the widespread knowledge of the COVID-19 pandemic, 24 of 164 (14.6%) patients who received naloxone via EMS refused transport. During the pandemic, 55 of 153 (35.9%) patients who received naloxone via EMS refused transport. Subjects receiving naloxone during the COVID-19 pandemic were at greater risk of refusal of transport than those receiving naloxone prior to the pandemic (RR = 2.45; 95% CI 1.6-3.76). Among those who did not receive naloxone, 2067 of 6956 (29.7%) patients were not transported prior to the COVID-19 pandemic and 2483 of 6016 (41.3%) were not transported during the pandemic. Subjects who did not receive naloxone with EMS were at greater risk of refusal of transport during the COVID-19 pandemic than prior to it (RR = 1.39; 95% CI 1.32-1.46). Conclusion: In this single EMS system, more than a two-fold increase in the rate of refusal after non-fatal opioid overdose was observed following the COVID-19 outbreak.
• Spaite, D. W., Cone, D. C., & Coats, T. J. (2020). Out-of-Hospital Tranexamic Acid for Traumatic Brain Injury. JAMA, 324(10), 946. doi:10.1001/jama.2020.9244
• Spaite, D. W., Rice, A. D., Keim, S. M., Jorgenson, D., Hu, C., Helfenbein, E., Gaither, J. B., Bradley, G., Barnhart, B. J., & Babaeizadeh, S. (2020). Abstract 200: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Circulation, 142. doi:10.1161/circ.142.suppl_4.200
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  Background: Respiratory rate (RR) is a key component in commonly-used trauma scoring systems [e.g., Revised Trauma Score (RTS), TRISS]. Imprecise documentation of RR introduces misclassification wh...
• Spaite, D. W., Rice, A. D., Keim, S. M., Jorgenson, D., Hu, C., Helfenbein, E., Gaither, J. B., Bradley, G., Barnhart, B. J., & Babaeizadeh, S. (2020). Abstract 277: Discrepancies Between Non-invasive Blood Pressure Monitor Data and Ems Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Circulation, 142. doi:10.1161/circ.142.suppl_4.277
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  Background: Recent studies have shown that prehospital systolic blood pressure (SBP) is strongly associated with mortality across a remarkably wide range (far above 90 mmHg) in traumatic brain inju...
• Spaite, D. W., Rice, A. D., Mullins, T., Keim, S. M., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bradley, G., Bobrow, B. J., & Barnhart, B. J. (2020). Abstract 362: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Circulation, 142. doi:10.1161/circ.142.suppl_4.362
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  Introduction: The Prehospital TBI Guidelines (PTGs) are intended for both isolated and multisystem TBI (ITBI/MTBI). However, uncontrolled hemorrhage and potential detrimental effects of fluid resus...
• Spaite, D. W., Silver, A., Rice, A. D., Mullins, T., Mullins, M., Mcdannold, R., Keim, S. M., Hu, C., Glenn, M., Gaither, J. B., Chikani, V., Bradley, G., Bobrow, B. J., & Barnhart, B. J. (2020). Abstract 156: Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests. Circulation, 142. doi:10.1161/circ.142.suppl_4.156
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  Background: Little is known about the ventilatory aspects of overdose-related OHCA (OD-OHCA). We compared maximum ETCO2 (mETCO2; each patient’s highest CO2 level) and mean for each recorded minute ...
• Beger, S., Sutter, J., Vadeboncoeur, T., Silver, A., Hu, C., Spaite, D. W., & Bobrow, B. (2019). Chest compression release velocity factors during out-of-hospital cardiac resuscitation. Resuscitation, 145, 37-42.
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  Smith G, Beger S, Vadeboncoeur T, Chikani V, Walter F, Spaite DW, Bobrow B: Trends in overdose-related out-of-hospital cardiac arrest in Arizona. Resuscitation. 2019(Jan);134:122-126. DOI: 10.1016/j.resuscitation.2018.10.019
• Bobrow, B. J., Vigil, N. H., Vadeboncoeur, T. F., Spaite, D. W., Perez, O., Grant, A. R., Chikani, V., Bobrow, B. J., & Blust, R. N. (2019). Death by Suicide-The EMS Profession Compared to the General Public.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 23(3), 340-345. doi:10.1080/10903127.2018.1514090
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  In 2016, nearly 45,000 deaths in the United States were attributed to suicide making this the 10th leading cause of death for all ages. National survey data suggest that among Emergency Medical Technicians (EMTs), including firefighters and Paramedics, rates of suicide are significantly higher than among the general public. EMTs face high levels of acute and chronic stress as well as high rates of depression and substance abuse, which increase their risk of suicide..To determine the statewide Mortality Odds Ratio (MOR) of suicide completion among EMTs as compared to non-EMTs in Arizona..We analyzed the Arizona Vital Statistics Information Management System Electronic Death Registry of all adult (≥18) deaths between January 1, 2009 and December 31, 2015. Manual review of decedent occupation was performed to identify the EMT cohort; all other deaths were included in the non-EMT cohort. Using the underlying cause of death as the outcome, we calculated the MOR of both the EMT and non-EMT cohorts..There were a total of 350,998 deaths during the study period with 7,838 categorized as suicide. The proportion of deaths attributed to suicide among EMTs was 5.2% (63 of 1,205 total deaths) while the percentage among non-EMTs was 2.2% (7,775/349,793) (p < 0.0001). The crude Mortality Odds Ratio for EMTs compared with non-EMTs was [cMOR 2.43; 95% CI (1.88-3.13)]. After adjusting for gender, age, race, and ethnicity, EMTs had higher odds that their death was by suicide than non-EMTs [aMOR: 1.39; 95% CI (1.06-1.82)]..In this statewide analysis, we found that EMTs had a significantly higher Mortality Odds Ratio due to suicide compared to non-EMTs. Further research is necessary to identify the underlying causes of suicide among EMTs and to develop effective prevention strategies.
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Rice, A. D., Mullins, T., Keim, S. M., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, D. (2019). Abstract 320: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: The EPIC4Kids Study. Circulation.
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  Introduction: The EPIC Study implemented the national EMS TBI Guidelines in a massive, statewide initiative (>11,000 providers trained, 133 agencies). While implementation was not associated with i...
• Bobrow, B. J., Walter, F. G., Vadeboncoeur, T. F., Spaite, D. W., Smith, G., Chikani, V., Bobrow, B. J., & Beger, S. (2019). Trends in overdose-related out-of-hospital cardiac arrest in Arizona.. Resuscitation, 134, 122-126. doi:10.1016/j.resuscitation.2018.10.019
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  Opioid overdose mortality has increased in North America; however, recent regional trends in the proportion of treated overdose-related out-of-hospital cardiac arrest (OD-OHCA) compared to out-of-hospital cardiac arrest of presumed cardiac etiology (C-OHCA) are largely unknown. Our aim is to assess trends in the prevalence and outcomes of OD-OHCAs compared to C-OHCAs in Arizona..Statewide, observational study utilizing an Utstein-style database with EMS-first care reports linked with hospital records, and vital statistics data from 2010 to 2015..There were 21,658 OHCAs during the study period. After excluding non-C-OHCAs, non-OD-OHCAs, and cases missing outcome data, 18,562 cases remained. Of these remaining cases, 17,591 (94.8%) were C-OHCAs and 971 (5.2%) were OD-OHCAs. There was a significant increase in the proportion of OD-OHCAs from 2010, 4.7% (95% CI: 3.9-5.5) to 2015, 6.6% (95% CI: 5.8-7.5). Mean age for OD-OHCAs was 38 years compared to 66 years for C-OHCAs, (p < 0.0001). Initial shockable rhythm was present in 7.1% of OD-OHCAs vs. 22.6% of C-OHCAs (p < 0.0001). Overall survival to discharge in the OD-OHCA group was 18.6% vs. 11.9% in C-OHCA (p < 0.0001). After risk adjustment, we found an aOR of 2.1 (95% CI: 1.8-2.6) for survival in OD-OHCA compared to C-OHCA..There has been a significant increase in the proportion of OD-OHCAs in Arizona between 2010-2015. OD-OHCA patients were younger, were less likely to present with a shockable rhythm, and more likely to survive than patients with C-OHCA. These data should be considered in prevention and treatment efforts.
• Hu, C., Keim, S. M., Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., & Rice, A. D. (2019). Abstract 326: Prehospital Use of Nasal Cannula End-Tidal CO ₂ Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation, 140(Suppl_2). doi:10.1161/circ.140.suppl_2.326
• Smith, G., Beger, S., Vadeboncoeur, T., Chikani, V., Walter, F., Spaite, D. W., & Bobrow, B. (2019). Trends in overdose-related out-of-hospital cardiac arrest in Arizona. Resuscitation, 134, 122-126. doi:10.1016/j.resuscitation.2018.10.019
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  Smith G, Beger S, Vadeboncoeur T, Chikani V, Walter F, Spaite DW, Bobrow B: Trends in overdose-related out-of-hospital cardiac arrest in Arizona. Resuscitation. 2019(Jan);134:122-126. DOI: 10.1016/j.resuscitation.2018.10.019. Epub 2018 Oct 22. Opioid overdose mortality has increased in North America; however, recent regional trends in the proportion of treated overdose-related out-of-hospital cardiac arrest (OD-OHCA) compared to out-of-hospital cardiac arrest of presumed cardiac etiology (C-OHCA) are largely unknown. Our aim is to assess trends in the prevalence and outcomes of OD-OHCAs compared to C-OHCAs in Arizona.
• Spaite, D. W., Bobrow, B. J., Keim, S. M., Barnhart, B., Chikani, V., Gaither, J. B., Sherrill, D., Denninghoff, K. R., Mullins, T., Adelson, P. D., Rice, A. D., Viscusi, C., & Hu, C. (2019). Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA surgery, 154(7), e191152.
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  Spaite DW, Bobrow BJ, Keim SM, Barnhart B, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Mullins T, Adelson PD, Rice AD, Viscusi C, Hu C: Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence In Prehospital Injury Care (EPIC) Study. JAMA Surg. 2019;154(7):e191152. doi:10.1001/jamasurg.2019.1152. Published online May 8
• Spaite, D. W., Rice, A. D., Keim, S. M., Jorgenson, D., Hu, C., Helfenbein, E., Gaither, J. B., Barnhart, B. J., & Babaeizadeh, S. (2019). Abstract 386: Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-Tidal CO2 and Level of Consciousness. Circulation.
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  Background: The EMS traumatic brain injury (TBI) guidelines encourage limiting prehospital intubation (ETI) to patients with profoundly depressed level of consciousness (LOC) and who cannot protect...
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Silver, A., Mcdannold, R., Chikani, V., & Bobrow, B. J. (2018). Quantification of ventilation volumes produced by compressions during emergency department cardiopulmonary resuscitation.. The American journal of emergency medicine, 36(9), 1640-1644. doi:10.1016/j.ajem.2018.06.057
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  Clinical investigations have shown improved outcomes with primary compression cardiopulmonary resuscitation strategies. It is unclear whether this is a result of passive ventilation via chest compressions, a low requirement for any ventilation during the early aspect of resuscitation or avoidance of inadvertent over-ventilation..To quantify whether chest compressions with guideline-compliant depth (>2 in) produce measurable and substantial ventilation volumes during emergency department resuscitation of out-of-hospital cardiac arrest..This was a prospective, convenience sampling of adult non-traumatic out-of-hospital cardiac arrest patients receiving on-going cardiopulmonary resuscitation in an academic emergency department from June 1, 2011 to July 30, 2013. Cardiopulmonary resuscitation quality files were analyzed using R-Series defibrillator/monitors (ZOLL Medical) and ventilation data were measured using a Non-Invasive Cardiac Output monitor (Philips/Respironics, Wallingford, CT)..cardiopulmonary resuscitation quality data were analyzed from 21 patients (17 males, median age 59). The median compression depth was 2.2 in (IQR = 1.9, 2.5) and the median chest compression fraction was 88.4% (IQR = 82.2, 94.1). We were able to discern 580 ventilations that occurred during compressions. The median passive tidal volume recorded during compressions was 7.5 ml (IQR 3.5, 12.6). While the highest volume recorded was 45.8 ml, 81% of the measured tidal volumes were
• Denninghoff, K. R., Barnhart, B. J., Bobrow, B. J., Hu, C., Spaite, D. W., Chikani, V., Gaither, J. B., Rice, A. D., & Keim, S. M. (2018). Abstract 230: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated vs. Multisystem Major Traumatic Brain Injury. Circulation, 138(Suppl_2). doi:10.1161/circ.138.suppl_2.230
• Gaither, J. B., Chikani, V., Stolz, U., Viscusi, C., Denninghoff, K., Barnhart, B., Mullins, T., Rice, A. D., Mhayamaguru, M., Smith, J. J., Keim, S. M., Bobrow, B. J., & Spaite, D. W. (2018). Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 21(5), 575-582.
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  Low body temperatures following prehospital transport are associated with poor outcomes in patients with traumatic brain injury (TBI). However, a minimal amount is known about potential associations across a range of temperatures obtained immediately after prehospital transport. Furthermore, a minimal amount is known about the influence of body temperature on non-mortality outcomes. The purpose of this study was to assess the correlation between temperatures obtained immediately following prehospital transport and TBI outcomes across the entire range of temperatures.
• Gaither, J. B., Mhayamaguru, K., Rice, A., Waters, K. E., Smith, J. J., Beskind, D. L., & Spaite, D. W. (2018). Use of Distance Education Tools to Improve the Rural EMS Experience for EMS Fellows. Prehospital Emergency Care.
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  Gaither JB, Mhayamaguru KM, Rice A, Waters KE, Smith JJ, Beskind D, Spaite DW. Use of Distance Education Tools to Improve the Rural EMS Experience for EMS Fellows. Prehospital Emerg Care 2018;22(1):152-153.
• McDannold, R., Bobrow, B. J., Chikani, V., Silver, A., Spaite, D. W., & Vadeboncoeur, T. (2018). Quantification of ventilation volumes produced by compressions during emergency department cardiopulmonary resuscitation. The American journal of emergency medicine, 36(9), 1640-1644. doi:10.1016/j.ajem.2018.06.057
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  McDannold R, Bobrow BJ, Chikani V, Silver A, Spaite DW, Vadeboncoeur T: Quantification of ventilation volumes produced by compressions during emergency department cardiopulmonary resuscitation. Am J Emerg Med. 2018 Sep;36(9):1640-1644. PMID: 30017691 DOI: 10.1016/j.ajem.2018.06.057Clinical investigations have shown improved outcomes with primary compression cardiopulmonary resuscitation strategies. It is unclear whether this is a result of passive ventilation via chest compressions, a low requirement for any ventilation during the early aspect of resuscitation or avoidance of inadvertent over-ventilation.
• Spaite, D. W., Rice, A. D., Perez, O., Keim, S. M., Jorgenson, D., Hu, C., Helfenbein, E., Barnhart, B. J., & Babaeizadeh, S. (2018). Abstract 235: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 via Nasal Cannula vs. Non-Rebreather Mask. Circulation.
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  Background: The advent of highly sensitive End-Tidal CO2 (ETCO2) sensors allows effective monitoring of intubated patients in many emergency care settings, including EMS. Previous work has explored...
• Spaite, D. W., Rice, A. D., Perez, O., Keim, S. M., Jorgenson, D., Hu, C., Helfenbein, E., Gaither, J. B., Barnhart, B. J., & Babaeizadeh, S. (2018). Abstract 233: Prehospital End-Tidal CO2 Measurement in Non-Intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation.
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  Background: End-Tidal CO2 (ETCO2) monitoring is valuable in the management of traumatic brain injury (TBI). In intubated patients it helps prevent hyper/over-ventilation. In non-intubated patients,...
• Vadeboncoeur, T. F., Chikani, V., Hu, C., Spaite, D. W., & Bobrow, B. J. (2018). Association between coronary angiography with or without percutaneous coronary intervention and outcomes after out-of-hospital cardiac arrest. Resuscitation, 127, 21-25.
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  Vadeboncoeur TF, Chikani V, Hu C, Spaite DW, Bobrow BJ: Association between coronary angiography with or without percutaneous coronary intervention and outcomes after out-of-hospital cardiac arrest. Resuscitation. 2018;127:21-25. doi: 10.1016/j.resuscitation.2018.03.023.3 The aim of our study was to assess the impact of coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) without ST-elevation (STE).
• Vigil, N. H., Grant, A. R., Perez, O., Blust, R. N., Chikani, V., Vadeboncoeur, T. F., Spaite, D. W., & Bobrow, B. J. (2018). Death by Suicide-The EMS Profession Compared to the General Public. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 1-6. doi:10.1080/10903127.2018.1514090
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  Vigil NH, Grant AR, Perez O, Blust RN, Chikani V, Vadeboncoeur TF, Spaite DW, Bobrow BJ: Death by Suicide: the EMS Profession Compared to the General Public. Prehospital Emerg Care. 2018;14:1-6. DOI: 10.1080/10903127.2018.1514090In 2016, nearly 45,000 deaths in the United States were attributed to suicide making this the 10th leading cause of death for all ages. National survey data suggest that among Emergency Medical Technicians (EMTs), including firefighters and Paramedics, rates of suicide are significantly higher than among the general public. EMTs face high levels of acute and chronic stress as well as high rates of depression and substance abuse, which increase their risk of suicide.
• Wu, Z., Wu, Z., Panczyk, M., Panczyk, M., Spaite, D. W., Spaite, D. W., Hu, C., Hu, C., Fukushima, H., Fukushima, H., Langlais, B., Langlais, B., Sutter, J., Sutter, J., Bobrow, B. J., & Bobrow, B. J. (2018). Telephone cardiopulmonary resuscitation is independently associated with improved survival and improved functional outcome after out-of-hospital cardiac arrest. Resuscitation, 122, 135-140.
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  Wu Z, Panczyk M, Spaite DW, Hu C, Fukushima H, Langlais B, Sutter J, Bobrow BJ: Telephone Cardiopulmonary Resuscitation is Independently Associated with Improved Survival and Improved Functional Outcome after Out-of-Hospital Cardiac Arrest. Resuscitation. 2018 Jan;122:135-140. pii: S0300-9572(17)30297-6. doi: 10.1016/j.resuscitation.2017.07.016This study aims to quantify the relative impact of Dispatcher-Initiated Telephone cardiopulmonary resuscitation (TCPR) on survival and survival with favorable functional outcome after out-of-hospital cardiac arrest (OHCA) in a population of patients served by multiple emergency dispatch centers and more than 130 emergency medical services (EMS) agencies.
• Bobrow, B. J., Spaite, D. W., Hu, C., Fukushima, H., Panczyk, M., Dameff, C., Chikani, V., & Vadeboncoeur, T. (2017). Description of Abnormal Breathing Is Associated With Improved Outcomes and Delayed Telephone Cardiopulmonary Resuscitation Instructions. Journal of the American Heart Association, 6(9). doi:10.1161/jaha.116.005058
• Bobrow, B. J., Spaite, D. W., Salevitz, D., Rodriguez, S. A., Panczyk, M., Nadkarni, V., Mullins, T., George, T. A., Chikani, V., Bobrow, B. J., & Berg, R. A. (2017). Abstract 13731: Telephone Cardiopulmonary Resuscitation Process Measures and Survival After Pediatric OHCA. Circulation.
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  Background: Telephone cardiopulmonary resuscitation (TCPR) is associated with improved patient outcomes after out-of-hospital cardiac arrest (OHCA). Compared with TCPR for adults, little is known a...
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Mullins, T., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2017). Mortality and Prehospital Blood Pressure in Patients With Major Traumatic Brain Injury: Implications for the Hypotension Threshold.. JAMA surgery, 152(4), 360-368. doi:10.1001/jamasurg.2016.4686
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  Current prehospital traumatic brain injury guidelines use a systolic blood pressure threshold of less than 90 mm Hg for treating hypotension for individuals 10 years and older based on studies showing higher mortality when blood pressure drops below this level. However, the guidelines also acknowledge the weakness of the supporting evidence..To evaluate whether any statistically supportable threshold between systolic pressure and mortality emerges from the data a priori, without assuming that a cut point exists..Observational evaluation of a large prehospital database established as a part of the Excellence in Prehospital Injury Care Traumatic Brain Injury Study. Patients from the preimplementation cohort (January 2007 to March 2014) 10 years and older with moderate or severe traumatic brain injury (Barell Matrix Type 1 classification, International Classification of Diseases, Ninth Revision head region severity score of 3 or greater, and/or Abbreviated Injury Scale head-region severity score of 3 or greater) and a prehospital systolic pressure between 40 and 119 mm Hg were included. The generalized additive model and logistic regression were used to determine the association between systolic pressure and probability of death, adjusting for significant/important confounders..The main outcome measure was in-hospital mortality..Among the 3844 included patients, 2565 (66.7%) were male, and the median (range) age was 35 (10-99) years. The model revealed a monotonically decreasing association between systolic pressure and adjusted probability of death across the entire range (ie, from 40 to 119 mm Hg). Each 10-point increase of systolic pressure was associated with a decrease in the adjusted odds of death of 18.8% (adjusted odds ratio, 0.812; 95% CI, 0.748-0.883). Thus, the adjusted odds of mortality increased as much for a drop from 110 to 100 mm Hg as for a drop from 90 to 80 mm Hg, and so on throughout the range..We found a linear association between lowest prehospital systolic blood pressure and severity-adjusted probability of mortality across an exceptionally wide range. There is no identifiable threshold or inflection point between 40 and 119 mm Hg. Thus, in patients with traumatic brain injury, the concept that 90 mm Hg represents a unique or important physiological cut point may be wrong. Furthermore, clinically meaningful hypotension may not be as low as current guidelines suggest. Randomized trials evaluating treatment levels significantly above 90 mm Hg are needed.
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Rice, A. D., Perez, O., Keim, S. M., Hu, C., Helfenbein, E., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Babaeizadeh, S. (2017). Accuracy of EMS Hypoxia Documentation Compared to Continuous Non-Invasive Monitor Data in Major Traumatic Brain Injury. Journal of Emergency Medicine, 53(3), 443. doi:10.1016/j.jemermed.2017.08.063
• Fukushima, H., Panczyk, M., Hu, C., Dameff, C., Chikani, V., Vadeboncoeur, T., Spaite, D. W., & Bobrow, B. J. (2017). Description of Abnormal Breathing Is Associated With Improved Outcomes and Delayed Telephone Cardiopulmonary Resuscitation Instructions. Journal of the American Heart Association, 6(9). doi:doi: 10.1161/JAHA.116.005058
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  Emergency 9-1-1 callers use a wide range of terms to describe abnormal breathing in persons with out-of-hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process.
• Gaither, J. B., Gaither, J. B., Chikani, V., Chikani, V., Stolz, U., Stolz, U., Viscusi, C. D., Viscusi, C. D., Denninghoff, K. R., Denninghoff, K. R., Barnhart, B., Barnhart, B., Mullins, T., Mullins, T., Rice, A., Rice, A., Mhayamaguru, K., Mhayamaguru, K., Smith, J. J., , Smith, J. J., et al. (2017). Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes. Prehospital Emergency Care, 21(5), 575-582. doi:10.1080/10903127.2017.1308609
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  Gaither JB, Chikani V, Stolz U, Viscusi C, Denninghoff K, Barnhart B, Mullins T, Rice AD, Mhayamaguru M, Smith JJ, Keim SM, Bobrow BJ, Spaite DW: Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes. Prehosp Emerg Care. 2017 Sep-Oct;21(5):575-582. doi: 10.1080/10903127.2017.1308609. Epub 2017 May 8. PubMed PMID: 28481163; NIH Manuscript System ID: NIHMS910946; PubMed Central PMCID: PMC5638643.
• Irisawa, T., Vadeboncoeur, T. F., Karamooz, M., Mullins, M., Chikani, V., Spaite, D. W., & Bobrow, B. J. (2017). Duration of Coma in Out-of-Hospital Cardiac Arrest Survivors Treated With Targeted Temperature Management. Annals of emergency medicine, 69(1), 36-43. doi:10.1016/j.annemergmed.2016.04.021
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  Irisawa T, Vadeboncoeur TF, Karamooz M, Mullins M, Chikani V, Spaite DW, Bobrow BJ: Duration of Coma in Out-of-Hospital Cardiac Arrest Survivors Treated With Targeted Temperature Management. Ann Emerg Med. 2017 Jan;69(1):36-43. doi: 10.1016/j.annemergmed.2016.04.021. PubMed PMID: 27238827.
• Langlais, B. T., Panczyk, M., Sutter, J., Fukushima, H., Wu, Z., Iwami, T., Spaite, D., & Bobrow, B. (2017). Barriers to patient positioning for telephone cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation, 115, 163-168.
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  9-1-1 callers often face barriers preventing them from starting Telephone CPR (TCPR). The most common problem is getting patients to a hard, flat surface. This study describes barriers callers report when trying to move patients to a hard, flat surface and assesses conditions associated with overcoming these barriers.
• Nuño, T., Bobrow, B. J., Rogge-Miller, K. A., Panczyk, M., Mullins, T., Tormala, W., Estrada, A., Keim, S. M., & Spaite, D. W. (2017). Disparities in telephone CPR access and timing during out-of-hospital cardiac arrest. Resuscitation, 115, 11-16. doi:10.1016/j.resuscitation.2017.03.028
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  Spanish-only speaking residents in the United States face barriers to receiving potentially life-saving 911 interventions such as Telephone -cardiopulmonary resuscitation (TCPR) instructions. Since 2015, 911 dispatchers have placed an increased emphasis on rapid identification of potential cardiac arrest. The purpose of this study was to describe the utilization and timing of the 911 system during suspected out-of-hospital cardiac arrest (OHCA) by Spanish-speaking callers in Metropolitan Phoenix, Arizona.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C., Mullins, T., & Sherrill, D. (2017). The Effect of Combined Out-of-Hospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. Annals of emergency medicine, 69(1), 62-72. doi:10.1016/j.annemergmed.2016.08.007
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  Survival is significantly reduced by either hypotension or hypoxia during the out-of-hospital management of major traumatic brain injury. However, only a handful of small studies have investigated the influence of the combination of both hypotension and hypoxia occurring together. In patients with major traumatic brain injury, we evaluate the associations between mortality and out-of-hospital hypotension and hypoxia separately and in combination.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C., Mullins, T., Rice, A. D., & Sherrill, D. (2017). Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality. Annals of emergency medicine, 70(4), 522-530.e1.
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  Out-of-hospital hypotension has been associated with increased mortality in traumatic brain injury. The association of traumatic brain injury mortality with the depth or duration of out-of-hospital hypotension is unknown. We evaluated the relationship between the depth and duration of out-of-hospital hypotension and mortality in major traumatic brain injury.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B. J., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Mullins, T., Sherrill, D., & Keim, S. M. (2017). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Mullins T, Sherrill D, Keim SM: Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation 2017
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Viscusi, C., Mullins, T., & Adelson, P. D. (2017). Mortality and Prehospital Blood Pressure in Patients With Major Traumatic Brain Injury: Implications for the Hypotension Threshold. JAMA surgery, 152(4), 360-368. doi:10.1001/jamasurg.2016.4686
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  Current prehospital traumatic brain injury guidelines use a systolic blood pressure threshold of less than 90 mm Hg for treating hypotension for individuals 10 years and older based on studies showing higher mortality when blood pressure drops below this level. However, the guidelines also acknowledge the weakness of the supporting evidence.
• Stolz, U., Smith, J. J., Bobrow, B. J., Viscusi, C., Stolz, U., Spaite, D. W., Smith, J. J., Rice, A. D., Mullins, T., Mhayamaguru, M., Keim, S. M., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., & Barnhart, B. J. (2017). Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 21(5), 575-582. doi:10.1080/10903127.2017.1308609
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  Low body temperatures following prehospital transport are associated with poor outcomes in patients with traumatic brain injury (TBI). However, a minimal amount is known about potential associations across a range of temperatures obtained immediately after prehospital transport. Furthermore, a minimal amount is known about the influence of body temperature on non-mortality outcomes. The purpose of this study was to assess the correlation between temperatures obtained immediately following prehospital transport and TBI outcomes across the entire range of temperatures..This retrospective observational study included all moderate/severe TBI cases (CDC Barell Matrix Type 1) in the pre-implementation cohort of the Excellence in Prehospital Injury Care (EPIC) TBI Study (NIH/NINDS: 1R01NS071049). Cases were compared across four cohorts of initial trauma center temperature (ITCT):
• Wu, Z., Panczyk, M., Spaite, D. W., Hu, C., Fukushima, H., Langlais, B., Sutter, J., & Bobrow, B. J. (2017). Telephone Cardiopulmonary Resuscitation is Independently Associated with Improved Survival and Improved Functional Outcome after Out-of-Hospital Cardiac Arrest. Resuscitation. doi:10.1016/j.resuscitation.2017.07.016
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  Wu Z, Panczyk M, Spaite DW, Hu C, Fukushima H, Langlais B, Sutter J, Bobrow BJ: Telephone Cardiopulmonary Resuscitation is Independently Associated with Improved Survival and Improved Functional Outcome after Out-of-Hospital Cardiac Arrest. Resuscitation. 2017 Jul 25. pii: S0300-9572(17)30297-6. doi: 10.1016/j.resuscitation.2017.07.016
• Bobrow, B. J., Langlais, B. T., Vadeboncoeur, T. F., Sutter, J., Spaite, D. W., Panczyk, M., Mullins, T., Langlais, B., Hu, C., & Bobrow, B. J. (2016). Abstract 13846: Telephone CPR is Independently Associated With an Increase in Initial Shockable Rhythms in Patients With Out-of-Hospital Cardiac Arrest. Circulation.
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  Background: Bystander CPR (BCPR) and telephone CPR (TCPR) are associated with improved OHCA outcomes. It has been shown that BCPR increases the proportion of patients with an initial shockable cardiac rhythm (VF/VT) when encountered by EMS. It is unknown whether TCPR does the same. Objective: To assess whether TCPR is independently associated with an increase in initial shockable cardiac rhythms during OHCA. Methods: Data from 9-1-1 audio recordings, first care EMS reports and hospital records were linked for OHCAs of presumed cardiac origin (1/2011-12/2014). Three cohorts were analyzed: TCPR, BCPR or no CPR. Using no CPR as the reference group, we assessed whether TCPR and BCPR were independently associated with initial shockable rhythms in a logistic regression model controlling for gender, event location, witness status and EMS response interval. Results: After exclusions, 2715 adult OHCA events with linked outcome data were analyzed (median age: 63; male: 66.8%; 33.3% witnessed arrest). Median respons...
• Bobrow, B. J., Spaite, D. W., Vadeboncoeur, T. F., Hu, C., Mullins, T., Tormala, W., Dameff, C., Gallagher, J., Smith, G., & Panczyk, M. (2016). Implementation of a Regional Telephone Cardiopulmonary Resuscitation Program and Outcomes After Out-of-Hospital Cardiac Arrest. JAMA Cardiology, 1(3), 294-302. doi:10:1001/jamacardiol.2016.0251
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  Bystander cardiopulmonary resuscitation (CPR) significantly improves survival from out-of-hospital cardiac arrest but is provided in less than half of events on average. Telephone CPR (TCPR) can significantly increase bystander CPR rates and improve clinical outcomes.
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Silver, A., Mullins, M., Mcdannold, R., Hu, C., Gaither, J., & Bobrow, B. J. (2016). Abstract 20338: Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Circulation, 134.
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  Introduction: While modest correlation between end-tidal CO 2 (ETCO 2 ) and CPR quality has been reported among patients who have arrested from presumed cardiac etiology, it is unknown whether this correlation exists in arrests of respiratory etiology. We compared the correlation between ETCO 2 and CPR quality among these two groups. Methods: ETCO 2 was monitored with side-stream CO 2 (Philips/Respironics or Oridion) and CPR quality with an accelerometer-based system (E/X Series, ZOLL Medical) during treatment of consecutive adult (age 18+) OHCA patients with presumed cardiac or respiratory etiology by two EMS agencies in Arizona (10/2008-6/2015). Minute-by-minute ETCO 2 and CPR quality data were extracted. Linear mixed effect models were fitted to use (log transformed) ETCO 2 level to predict four CPR variables: chest compression (CC) depth, (log) CC rate, CC release velocity (CCRV), and (log) ventilation rate (VR). An interaction term was used to test for differential correlation between the 2 groups. A random intercept for each case was included and a spatial power covariance structure assumed for measurements over time. Results: A total of 399 subjects (median age: 68 yrs, 63% male, 374 cardiac etiology, 25 respiratory) with 2812 minutes of data were studied. ETCO 2 was correlated with CC rate for respiratory etiology (p = .011) but not for cardiac etiology and the difference was marginally significant (p = .085). ETCO2 was correlated with VR for cardiac etiology (p 2 was associated with an increase of 8.7mm/s (95% CI: 3.9, 13.5) in CCRV for cardiac etiology and 12.1mm/s (95% CI: -1.8, 26) for respiratory etiology but the difference between etiologies was not significant. Correlation between ETCO 2 and CC depth was similar between the 2 groups. In both cohorts, ETCO 2 explained Conclusion: Correlations between ETCO 2 and certain CPR variables were different for patients with cardiac vs respiratory etiology. ETCO 2 may not be an adequate substitute for CPR quality monitoring in either situation. Future studies are needed to determine how ETCO 2 and CPR quality monitoring can be used in combination to optimize CPR.
• Bobrow, B. J., Vadeboncoeur, T. F., Sutter, J., Spaite, D. W., Silver, A., Mullins, M., Mcdannold, R., Hu, C., Bobrow, B. J., & Beger, S. (2016). Abstract 20257: Decline in Chest Compression Release Velocity Over Time is Associated With Out-of-Hospital Cardiac Arrest Outcomes. Circulation.
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  Background: High chest compression release velocity (CCRV) has been independently associated with improved outcomes after out-of-hospital cardiac arrest (OHCA). We assessed the change in CCRV over ...
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Mullins, T., Keim, S. M., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2016). Abstract 15910: Evaluation of Prehospital Hypotension Depth-duration Dose and Mortality in Major Traumatic Brain Injury. Circulation, 134.
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  Objective: Prehospital hypotension [systolic BP (SBP)
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Perez, O., Keim, S. M., Hu, C., Helfenbein, E., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Babaeizadeh, S. (2016). Abstract 15795: Prehospital Use of Nasal Cannula End-tidal CO2 Monitoring in Non-intubated Major Traumatic Brain Injury Patients. Circulation.
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  Background: Little is known about end-tidal CO2 monitoring using nasal cannula sensors in non-intubated patients (NC-ETCO2). Objective: To describe the patterns of NC-ETCO2 seen during the EMS care...
• Fukushima, H., Panczyk, M., Spaite, D. W., Chikani, V., Dameff, C., Hu, C., Birkenes, T. S., Myklebust, H., Sutter, J., Langlais, B., Wu, Z., & Bobrow, B. J. (2016). Barriers to telephone cardiopulmonary resuscitation in public and residential locations. Resuscitation, 109, 116-120. doi:10.1016/j.resuscitation.2016.07.241
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  Emergency medical telecommunicators can play a key role in improving outcomes from out-of-hospital cardiac arrest (OHCA) by providing instructions for cardiopulmonary resuscitation (CPR) to callers. Telecommunicators, however, frequently encounter barriers that obstruct the Telephone CPR (TCPR) process. The nature and frequency of these barriers in public and residential locations have not been well investigated. The aim of this study is to identify the barriers to TCPR in public and residential locations.
• Fukushima, H., Panczyk, M., Spaite, D., Chikani, V., Dameff, C., Hu, C., Birkenes, T., Myklebust, H., Sutter, J., Langlais, B., Wu, Z., & Bobrow, B. (2016). Barriers to telephone cardiopulmonary resuscitation in public and residential locations. Resuscitation, 109. doi:10.1016/j.resuscitation.2016.07.241
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  Aim Emergency medical telecommunicators can play a key role in improving outcomes from out-of-hospital cardiac arrest (OHCA) by providing instructions for cardiopulmonary resuscitation (CPR) to callers. Telecommunicators, however, frequently encounter barriers that obstruct the Telephone CPR (TCPR) process. The nature and frequency of these barriers in public and residential locations have not been well investigated. The aim of this study is to identify the barriers to TCPR in public and residential locations. Methods We conducted a retrospective study of audio recordings of EMS-confirmed OHCAs from eight regional 9-1-1 dispatch centers between January 2012 and December 2013. Results We reviewed 1850 eligible cases (public location OHCAs: N = 223 and residential location OHCAs: N = 1627). Telecommunicators less frequently encountered barriers such as inability to calm callers in public than in residential locations (2.1% vs 8.5%, p = 0.002) or inability to place victims on a hard flat surface (13.9% vs 25.4%, p < 0.001). However, the barrier where callers were not with patients was more frequently observed in public than in residential locations (11.8% vs 2.7%, p < 0.001). Conclusions This study revealed that barriers to TCPR are distributed differently across public and residential locations. Understanding these differences can aid in the development of strategies to enhance bystander CPR and improve overall patient outcomes.
• Martin-Gill, C., Gaither, J. B., Bigham, B. L., Myers, J. B., Kupas, D. F., & Spaite, D. W. (2016). National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders. Prehospital Emergency Care, 20(2), 175-183. doi:10.3109/10903127.2015.1102995
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  Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy proposes that key stakeholder organizations financially support the Prehospital Guidelines Consortium as a means of implementing the Strategy, while together promoting additional funding for continued EBG efforts.
• Murphy, R. A., Bobrow, B. J., Spaite, D. W., Hu, C., McDannold, R., & Vadeboncoeur, T. F. (2016). Association between Prehospital CPR Quality and End-Tidal Carbon Dioxide Levels in Out-of-Hospital Cardiac Arrest. Prehospital Emergency Care, 20(3), 369-77. doi:10.3109/10903127.2015.1115929
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  International Guidelines recommend measurement of end-tidal carbon dioxide (EtCO2) to enhance cardiopulmonary resuscitation (CPR) quality and optimize blood flow during CPR. Numerous factors impact EtCO2 (e.g., ventilation, metabolism, cardiac output), yet few clinical studies have correlated CPR quality and EtCO2 during actual out-of-hospital cardiac arrest (OHCA) resuscitations. The purpose of this study was to describe the association between EtCO2 and CPR quality variables during OHCA.
• Sherrill, D. L., Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Perez, O., Keim, S. M., Hu, C., Helfenbein, E., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Babaeizadeh, S. (2016). Abstract 13835: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation.
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  Background: It is well established that prehospital hypoxia dramatically increases mortality in Traumatic Brain Injury (TBI). Thus, in EMS TBI research, case ascertainment and risk-adjustment are highly dependent upon documentation of in-field O2 saturation. Objective: To compare the rate of hypoxia identified by EMS personnel and documented in EMS patient care records (PCR) vs the actual rate of hypoxia recorded by continuous, non-invasive monitor in TBI. Methods: A subset of major TBI cases (moderate/severe) in the EPIC EMS TBI Study (NIH 1R01NS071049) were evaluated (3/30/13-6/26/15). Cases from 4 EMS agencies that report continuous monitor data (Philips MRx™) as part of EPIC were included. All monitor data available for post-hoc review were displayed and accessible to the providers during EMS care. We compared PCR documentation of hypoxia (O2 sat
• Tormala, W., Spaite, D. W., Bobrow, B. J., Vadeboncoeur, T. F., Hu, C., Mullins, T., Dameff, C., Gallagher, J., Smith, G., & Panczyk, M. (2016). Implementation of a Regional Telephone Cardiopulmonary Resuscitation Program and Outcomes After Out-of-Hospital Cardiac Arrest. JAMA Cardiology, 1(3), 294. doi:10.1001/jamacardio.2016.0251
• Bobrow, B. J., Langlais, B. T., Vadeboncoeur, T. F., Tully, J., Sutter, J., Spaite, D. W., Panczyk, M., Langlais, B., Dameff, C., Chikani, V., & Bobrow, B. J. (2015). Abstract 12075: Telecommunicator CPR Intervention Improves Recognition of Cardiac Arrest and Time to First Chest Compression. Circulation, 132.
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  Background: Bystander cardiopulmonary resuscitation (BCPR) significantly improves survival from out-of-hospital cardiac arrest (OHCA). Telecommunicator CPR (TCPR) has been shown to increase BCPR ra...
• Bobrow, B. J., Spaite, D. W., & McNally, B. (2015). Focus on Quality: Cardiac Arrest Registry to Enhance Survival to Begin Collecting Data to Measure CPR Quality. Journal of Emergency Medical Services, 40(5), 56-8.
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  Bobrow BJ, Spaite DW, McNally BF. Focus on Quality. JEMS 2015;40(5):56-8, 63. PubMed PMID: 26302645
• Bobrow, B. J., Spaite, D. W., & McNally, B. F. (2015). FOCUS ON QUALITY. JEMS : a journal of emergency medical services, 40(5), 56-8, 63.
• Bobrow, B. J., Stolz, U., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Silver, A., Roosa, J., Page, R., Lovecchio, F., Dameff, C., Crowe, C., & Bobrow, B. J. (2015). Measuring and improving cardiopulmonary resuscitation quality inside the emergency department.. Resuscitation, 93, 8-13. doi:10.1016/j.resuscitation.2015.04.031
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  To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality..CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing..A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p < 0.001), with the percentage of CC ≥ 51 mm increasing from 30.6% in P1 to 87.4% in P2 (p < 0.001). CC release velocity increased from 314 ± 25 mm/s in P1 to 442 ± 20 mm/s in P2 (p < 0.001). No significant differences were identified in CC fraction (84.3% P1 vs. 88.4% P2, p = 0.1), CC rate (125 ± 3 cpm P1 vs. 125 ± 3 cpm P2, p = 0.7), or pre-shock pause (9.7s P1 vs. 5.9s P2, p = 0.5), though CC fraction and pre-shock pause were within guideline recommendations..Implementation of the bundle of scenario-based training, real-time audiovisual CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department.
• Bobrow, B. J., Stolz, U., Viscusi, C., Stolz, U., Spaite, D. W., Sherrill, D. L., Mullins, T., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2015). Abstract 14938: Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. Circulation.
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  Introduction: Little is known about prehospital EMS blood pressure patterns in TBI and the effect of serial trends in BP during EMS care remains entirely unclear. Using the comprehensive, linked EM...
• Bobrow, B. J., Vadeboncoeur, T. F., Tully, J., Spaite, D. W., Panczyk, M., Murphy, R. A., Kannan, V., Dameff, C., & Bobrow, B. J. (2015). Abstract 12080: 9-1-1 Caller Descriptions of Gasping During Out-of-Hospital Cardiac Arrest. Circulation.
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  Background: Abnormal breathing, or “gasping,” frequently occurs during cardiac arrest and has been associated with increased survival. During 9-1-1 calls, early recognition of gasping may allow dis...
• Bobrow, B. J., Williams, C. M., Williams, C. M., Spaite, D. W., Mhayamaguru, M., Keim, S. M., Galson, S. W., Gaither, J. B., Curry, M., & Bobrow, B. J. (2015). Environmental Hyperthermia in Prehospital Patients with Major Traumatic Brain Injury.. The Journal of emergency medicine, 49(3), 375-81. doi:10.1016/j.jemermed.2015.01.038
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  Traumatic brain injury (TBI) results in an estimated 1.7 million emergency department visits each year in the United States. These injuries frequently occur outside, leaving injured individuals exposed to environmental temperature extremes before they are transported to a hospital..Evaluate the existing literature for evidence that exposure to high temperatures immediately after TBI could result in elevated body temperatures (EBTs), and whether or not EBTs affect patient outcomes..It has been clear since the early 1980s that after brain injury, exposure to environmental temperatures can cause hypothermia, and that this represents a significant contributor to increased morbidity and mortality. Less is known about elevated body temperature. Early evidence from the Iraq and Afghanistan wars indicated that exposure to elevated environmental temperatures in the prehospital setting may result in significant EBTs, however, it is unclear what impact these EBTs might have on outcomes in TBI patients. In the hospital, EBT, or neurogenic fever, is thought to be due to the acute-phase reaction that follows critical injury, and these high body temperatures are associated with poor outcomes after TBI..Hospital data suggest that EBTs are associated with poor outcomes, and some preliminary reports suggest that early EBTs are common after TBI in the prehospital setting. However, it remains unclear whether patients with TBI have an increased risk of EBTs after exposure to high environmental temperatures, or if this very early "hyperthermia" might cause secondary injury after TBI.
• Crowe, C., Bobrow, B. J., Vadeboncoeur, T. F., Dameff, C., Stolz, U., Silver, A., Roosa, J., Page, R., LoVecchio, F., & Spaite, D. W. (2015). Measuring and improving cardiopulmonary resuscitation quality inside the emergency department. Resuscitation, 93(8), 8-13. doi:10.1016/j.resuscitation.2015.04.031
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  To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality.
• Ewy, G. A., Bobrow, B. J., Chikani, V., Sanders, A. B., Otto, C. W., Spaite, D. W., & Kern, K. B. (2015). The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest. Resuscitation, 96, 180-5. doi:10.1016/j.resuscitation.2015.08.011
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  Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial.
• Gaither, J. B., Galson, S., Curry, M., Mhayamaguru, M., Williams, C., Keim, S. M., Bobrow, B. J., & Spaite, D. W. (2015). Environmental Hyperthermia in Prehospital Patients with Major Traumatic Brain Injury. The Journal of Emergency Medicine, 49(3), 375-381. doi:10.1016/j.jemermed.2015.01.038
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  Traumatic brain injury (TBI) results in an estimated 1.7 million emergency department visits each year in the United States. These injuries frequently occur outside, leaving injured individuals exposed to environmental temperature extremes before they are transported to a hospital.
• Hypes, C., Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Silver, A., Mullins, M., Mcdannold, R., Irisawa, T., Hypes, C., & Bobrow, B. J. (2015). Abstract 17760: Maintaining High Quality CPR With an Integrated Manual/Mechanical Resuscitation Protocol. Circulation.
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  Background: High quality manual chest compressions (CC) can be achieved on scene during resuscitation of cardiac arrest patients, but manual CC quality can deteriorate during patient extrication and transport. The purpose of this study was to describe the effect on CC quality of an integrated manual/mechanical chest compression protocol developed to maintain CC quality and patient/provider safety throughout resuscitation. Methods: CC quality was monitored using a monitor with accelerometer-based CC sensing (E Series/X Series, ZOLL Medical) during the treatment of consecutive out-of-hospital cardiac arrest patients between 3/1/2013-4/30/2015. The EMS agency performed manual CC guided by real-time audiovisual feedback on scene but deployed the AutoPulse load-distributing band CC device (LDB, ZOLL Medical) in a choreographed manner for extrication and transport. The LDB was also placed prophylactically on patients after ROSC. Descriptive statistics are reported as median (IQR). Results: A total of 71 OHCA pa...
• Hypes, C., Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Silver, A., Murphy, R. A., Hypes, C., Hu, C., & Bobrow, B. J. (2015). Abstract 18435: ETCO2 Alone is Inadequate to Verify CPR Quality. Circulation, 132.
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  Background: Previous studies have described modest correlation between end-tidal CO 2 (ETCO 2 ) and CPR quality during resuscitation of cardiac arrest patients, but it is unclear whether ETCO 2 alone can indicate CPR quality. The present study investigated whether ETCO 2 adequately identifies the quality of CPR provided during out-of-hospital cardiac resuscitation. Methods: ETCO 2 was monitored with side-stream CO 2 (Philips/Respironics) and CPR quality measured with an accelerometer-based system (E Series, ZOLL Medical) during the treatment of consecutive adult OHCA patients with presumed cardiac etiology by 2 EMS agencies in the Arizona SHARE QI Program between 10/08-06/13. Minute-by-minute ETCO 2 and CPR quality were extracted. ETCO 2 values were log transformation to achieve approximate normality. Linear mixed effect models were fitted to use (transformed) ETCO 2 level to predict four CPR variables: chest compression (CC) depth, CC rate, CC release velocity (CCRV), and ventilation rate (VR). A random intercept for each case was included and a spatial power covariance structure assumed for measurements over time. Results: 230 subjects (median age 69 yrs, 69% male) with 1581 minutes of data were studied. Transformed ETCO 2 was significant for CC depth (p 2 was not a significant predictor for CC rate (p=0.89). The Figure illustrates the overlap in CC depth over quartiles of ETCO 2 , demonstrating that any specific ETCO 2 level could be found over a wide range of CC depths. Conclusion: In this secondary analysis, ETCO 2 was not an independent indicator of CC rate but was a weak predictor for CC depth, CCRV and VR. These findings suggest that ETCO 2 may be not be an adequate substitute for CPR quality monitoring. Future studies should investigate how ETCO 2 and CPR quality monitoring can be used in conjunction to optimize CPR.
• Hypes, C., Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Silver, A., Murphy, R. A., Mcdannold, R., Hypes, C., Hu, C., & Bobrow, B. J. (2015). Abstract 19572: Elevated PETCO2 During Cardiac Resuscitation Without Return of Spontaneous Circulation. Circulation.
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  Background: Quantitative End-Tidal CO2 (PETCO2) measurement during cardiac arrest is recommended for monitoring the CPR quality to detect ROSC. While low ETC02 can reflect suboptimal CPR quality and increases in ETC02 are often associated with ROSC the significance of high values of PETCO2 without ROSC remain unclear. Objectives: To describe the population of OHCA victims with high PETCO2 (>50 mm Hg) during ongoing resuscitation including demographics, rhythm characteristics, occurrence of ROSC, the later occurrence of field termination of resuscitation and the presumed etiology. Methods: An observational analysis of adult OHCAs with available PETCO2 data occurring between Oct 2010 and Nov 2014 at two sites involved in the Save Hearts in Arizona Registry and Education (SHARE) quality improvement program. CPR and PETCO2 data were recorded using ZOLL E and X Series EMS monitors. PETCO2 is reported as the mean value for each minute. The cardiac rhythm and the presence of ROSC were determined for each minute ...
• Indik, J. H., Conover, Z., McGovern, M., Silver, A. E., Spaite, D. W., Bobrow, B. J., & Kern, K. B. (2015). Amplitude-spectral area and chest compression release velocity independently predict hospital discharge and good neurological outcome in ventricular fibrillation out-of-hospital cardiac arrest. Resuscitation, 92, 122-8. doi:10.1016/j.resuscitation.2015.05.002
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  In out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) the frequency-based waveform characteristic, amplitude-spectral area (AMSA) is associated with hospital discharge and good neurological outcome, yet AMSA is also known to increase in response to chest compressions (CC). In addition to rate and depth, well performed CC provides good chest recoil without leaning, reflected in the release velocity (RV). We hypothesized that AMSA is associated with hospital discharge and good neurological outcome independent of CC quality.
• Kovacs, A., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Irisawa, T., Silver, A., & Bobrow, B. J. (2015). Chest compression release velocity: Association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest. Resuscitation, 92, 107-14. doi:10.1016/j.resuscitation.2015.04.026
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  We evaluated the association between chest compression release velocity (CCRV) and outcomes after out-of-hospital cardiac arrest (OHCA).Chest compression release velocity: Association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest. Resuscitation
• Moon, S., Vadeboncoeur, T. F., Kortuem, W., Kisakye, M., Karamooz, M., White, B., Brazil, P., Spaite, D. W., & Bobrow, B. J. (2015). Analysis of out-of-hospital cardiac arrest location and public access defibrillator placement in Metropolitan Phoenix, Arizona. Resuscitation, 89, 43-9. doi:10.1016/j.resuscitation.2014.10.029
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  Automated external defibrillators (AEDs) improve outcomes from out-of-hospital cardiac arrest (OHCA) but are infrequently used. We sought to compare the locations of OHCAs and AEDs in metropolitan Phoenix, Arizona.
• Mosier, J. M., Kelsey, M., Raz, Y., Gunnerson, K. J., Meyer, R., Hypes, C. D., Malo, J., Whitmore, S. P., & Spaite, D. W. (2015). Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Critical Care, 19, 431-439. doi:10.1186/s13054-015-1155-7
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  Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.
• Panchal, A. R., Gaither, J. B., Svirsky, I., Prosser, B., Stolz, U., & Spaite, D. W. (2015). The Impact of Professionalism on Transfer of Care to the Emergency Department. The Journal of Emergency Medicine, 49(1), 18-25. doi:10.1016/j.jemermed.2014.12.062
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  Patient care transfer from Emergency Medical Services (EMS) to the emergency department (ED) providers is a transition point where there are high rates of information degradation and variability in perceptions of handoff quality.
• Smith, J. J., Bobrow, B. J., Viscusi, C., Spaite, D. W., Smith, J. J., Mhayamaguru, M., Gaither, J. B., Denninghoff, K. R., Curry, M., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2015). Abstract 16144: Association Between Elevated Initial Trauma Center Body Temperature and Non-mortality Outcomes Following Major Traumatic Brain Injury. Circulation, 132.
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  Introduction: During prolonged hospitalization for Traumatic Brain Injury (TBI), fever has been identified as a possible cause of secondary brain injury and previous reports have identified an association between elevated body temperature and increased mortality following TBI. However, little is known about the relationship between an elevated initial trauma center body temperature (ITCT), measured immediately after EMS transport, and non-mortality outcomes. The purpose of this study was to determine if a correlation exists between elevated ITCT and various important patient outcomes. Methods: All moderate/severe TBI cases (CDC Barell Matrix Type 1) in the Arizona State Trauma Registry (ASTR; 1/1/07-12/31/12) were analyzed by the following ITCT categories: 36.5-37.9°C (normal-NT), 38.0-38.9°C (elevated-ET) and ≥39.0°C (very elevated-VET). Outcomes included: Trauma Center (TC) length-of-stay (LOS), Intensive Care Unit (ICU) LOS, and total TC charges. For continuous variables, non-parametric Kruskal-Wallis test was used to assess the median difference between the ET and VET cohorts and the NT group (reference). Wilcoxon two-sample tests identified groups with significant differences (alpha = 0.05). Results: 22,925 cases met inclusion criteria (exclusions: missing ITCT-2,885; missing demographics-700; ITCT Conclusion: In this statewide study, ET or VET were associated with longer ICU LOS, longer hospital LOS and increased hospital charges. Future work is needed to identify the causes of temperature elevations that occur during prehospital TBI care (e.g., environmental factors versus autonomic dysregulation) and whether initiation of in-field measures to prevent temperature elevation might improve outcome.
• Stolz, U., Svirsky, I., Stolz, U., Spaite, D. W., Prosser, B., Panchal, A. R., & Gaither, J. B. (2015). The Impact of Professionalism on Transfer of Care to the Emergency Department.. The Journal of emergency medicine, 49(1), 18-25. doi:10.1016/j.jemermed.2014.12.062
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  Patient care transfer from Emergency Medical Services (EMS) to the emergency department (ED) providers is a transition point where there are high rates of information degradation and variability in perceptions of handoff quality..To evaluate EMS and ED provider perceptions of information transfer compared to an external observer's objective assessment..This evaluation is a review of a quality-improvement database at an academic trauma center. EMS to ED patient transfers were attended by trained external observers who recorded communicated data and evaluated provider professionalism. After handoff, EMS and ED staff rated their own perceptions of the transfer..Trained observers evaluated 1091 patient transfers. The perceived transfer quality was similar between EMS and ED staff, while trained observer ratings were different from EMS (odds ratio [OR] = 13.1; p < 0.001) and ED staff perceptions (OR = 20.2; p < 0.001). The EMS and ED staff perceptions were not influenced by absence of vital signs or demographics, but were affected by the perceived provider professionalism (EMS: OR = 2.4; p < 0.001; ED staff: OR = 1.5; p = 0.03)..This project is the largest evaluation of perceptions of ED transfers of care. During these transfers, significant key clinical information was not passed from EMS to ED staff. This did not have an association with EMS and ED staff transfer perception. Professionalism did affect attitudes concerning quality transfers of are. Future studies should focus on methods to improve information transfer while maximizing the subjective qualities of professional EMS-ED interactions.
• Sutter, J., Panczyk, M., Spaite, D. W., Ferrer, J. M., Roosa, J., Dameff, C., Langlais, B., Murphy, R. A., & Bobrow, B. J. (2015). Telephone CPR Instructions in Emergency Dispatch Systems: Qualitative Survey of 911 Call Centers. The Western Journal of Emergency Medicine, 16(5), 736-42. doi:10.5811/westjem.2015.6.26058
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  Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. The 2010 American Heart Association Emergency Cardiovascular Care (ECC) Guidelines recognize emergency dispatch as an integral component of emergency medical service response to OHCA and call for all dispatchers to be trained to provide telephone cardiopulmonary resuscitation (T-CPR) pre-arrival instructions. To begin to measure and improve this critical intervention, this study describes a nationwide survey of public safety answering points (PSAPs) focusing on the current practices and resources available to provide T-CPR to callers with the overall goal of improving survival from OHCA.
• Bobrow, B. J., Langlais, B. T., Spaite, D. W., Sotelo, M., Ryoo, H. W., Panczyk, M., Langlais, B., Jaber, J., Irisawa, T., & Bobrow, B. J. (2014). Abstract 113: Barriers to Effective Bystander-Initiated CPR in Out-of-Hospital Cardiac Arrest. Circulation, 130.
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  Background: Telephone-CPR can increase bystander CPR (BCPR) and survival in out-of-hospital cardiac arrest (OHCA). Studies show that CPR is more effective when delivered on the ground than on other surfaces, but patients often collapse in locations suboptimal for CPR. Objectives: To assess patient found locations (PFL) and barriers to initiating effective BCPR. Methods: Standardized review of audio recordings from confirmed OHCAs in a large, regional 9-1-1 dispatch center. OHCA was identified in 2,812 recordings (2/2011-6/2013). Caller-described barriers were categorized and recorded in a structured data format. Results: Cases were excluded if at least one of the following was observed: CPR was not indicated (n=770, 27.4%), CPR was already in progress (n=607, 21.6%), the caller was not with the patient (n=132, 4.7%), a language barrier was present between caller and dispatcher (n=63, 2.2%), the patient had a do-not-resuscitate order (n=33, 1.2%), or the patient displayed obvious signs of rigor mortis (n=1...
• Bobrow, B. J., Spaite, D. W., Silver, A., Mcdannold, R., Herken, U., Geheb, F. J., Crowe, C., Bronnenkant, T., & Bobrow, B. J. (2014). Abstract 346: Passive Ventilation During Cardiopulmonary Resuscitation Inside the Emergency Department. Circulation, 130.
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  Background: Continuing high quality chest compressions (CC) without interruption for active positive pressure ventilation (PPV) early in CPR has been demonstrated to improve patient outcomes in out-of-hospital cardiac arrest (OHCA). During the first minutes of CPR, passive oxygenation may be sufficient for oxygenating vital tissues. However, less is known about the later minutes of CPR. To evaluate this issue, in OHCA patients after hospital arrival, we quantified ventilation volumes during CCs in the ED. Methods: CPR quality metrics were obtained on patients who had CPR inside the ED with the E-Series defibrillator/monitor (Zoll Medical). Detailed ventilation data were obtained using a Non-Invasive Cardiac Output (NICO) Monitor (Philips/Respironics) with a CO2/flow sensor placed at the endotracheal tube. NICO waveform and breath-by-breath data were captured to measure ventilation volume associated with CCs. Results: Data files on 21 cardiac arrest patients who presented to the ED were included. [Male: 17, median age: 59 (IQR 47, 72)]. A total of 29,935 compressions (CCs) were analyzed [median depth 2.1 in (IQR=1.9, 2.5), median rate 126 CC/min (IQR=122-129). The median passive tidal volume during CCs was 5.8 mL, (IQR 3.4, 11.0). The highest volume was 124 mL, however 81% of the measured tidal volumes were Conclusion: This quantified analysis of ventilation volumes during chest compressions in the ED suggests that significant passive ventilation volumes may not occur later in CPR. Even in patients who were receiving effective compressions, passive tidal volumes were extremely low overall, suggesting that the value of compression only CPR may, in part, be due to the avoidance of the harmful effects of hyperventilation rather than any potential effect of passive ventilation.
• Bobrow, B. J., Stolz, U., Langlais, B. T., Vadeboncoeur, T. F., Sutter, J., Stolz, U., Spaite, D. W., Sotelo, M., Panczyk, M., Langlais, B., & Bobrow, B. J. (2014). Abstract 1: Statewide Implementation of a Standardized Prearrival Telephone CPR Program Is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest. Circulation, 130.
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  Background: Bystander CPR (BCPR) increases survival from OHCA yet is provided in a minority of cases. The AHA has promulgated guidelines on the provision of pre-arrival Telephone CPR (TCPR) instructions and measurement to increase the proportion of BCPR; however, the impact of those guidelines on survival is unknown. Objective: To describe the impact of a comprehensive bundle of 9-1-1 TCPR protocol, training, data collection, and feedback on BCPR and survival from OHCA across the state of Arizona. Methods: 9-1-1 audio recordings of confirmed OHCAs and suspected OHCAs (10/2010-6/2013) in 7 large 9-1-1 centers were reviewed using a standardized time-stamp methodology linked with EMS and hospital process and outcome data. There were 2343 pre-implementation cases (P1) and 2291 cases post-implementation of a bundle of care (P2) that included staff training and guideline-based protocol changes, data collection and feedback to providers. Univariate and multivariable analyses were used to assess outcomes between ...
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Ryoo, H. W., Mullins, M., Irisawa, T., Chikani, V., & Bobrow, B. J. (2014). Abstract 235: Emergent PCI Is Associated with Good Neurological Outcome After OHCA. Circulation, 130.
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  Background: Previous observational studies have demonstrated that outcomes after OHCA can be significantly improved with therapies such as mild therapeutic hypothermia and percutaneous coronary intervention (PCI). However, the optimal candidate and timing for PCI in OHCA remains unknown. This study aimed to assess the impact of emergent PCI on survival and neurological outcome after OHCA. Methods: This is a prospective observational study from a statewide OHCA database in Arizona. Patients included were greater than 18 years old who received CPR and were admitted to one of 34 recognized cardiac receiving centers. Patients who did not achieve ROSC, died within 2 hours of hospital arrival, and DNAR patients were excluded since the likelihood of PCI impacting outcome in these patients is questionable. An in-hospital post-arrest database, including PCI (Y/N), was linked with an Utstein-style OHCA database. Univariate and multivariate logistic regression were utilized to assess the association between PCI and survival to hospital discharge and neurological outcome. Results: During this study period (1-1-2011-12-31-2013), there were a total of 6,543 adult OHCA patients. After exclusions, 782 patients with suspected cardiac etiology OHCA were analyzed. The median age of patients was 64.0 years (Q1:54.0, Q3:73.0) and 70.2% were male. Among them 458 (58.6%) and 238 (30.4%) patients underwent the emergency coronary angiogram (CAG), and Primary PCI, respectively. Among PCI patients, the rate of survival to hospital discharge was 75.2%, vs. 60.4% for those without PCI (p Conclusion: This study shows an association with emergent PCI and good neurologic outcome after OHCA. Further study is necessary to determine a potential causal relationship between PCI and outcome.
• Bobrow, B. J., Zuercher, M., Spaite, D. W., Sanders, A. B., Otto, C. W., Kern, K. B., Ewy, G. A., Chikani, V., & Bobrow, B. J. (2014). Abstract 110: The Association Between the Timing of Epinephrine (Adrenalin) Administration and Survival from Out-of-Hospital Ventricular Fibrillation Arrest. Circulation.
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  Introduction: The benefit of epinephrine administration by emergency medical services providers (EMS) during resuscitation of patients with out-of-hospital-cardiac arrest (OHCA) is controversial. To address the association of the timing of epinephrine administration and outcome, we accessed the Save Hearts in Arizona Register and Educational (SHARE) program registry, and analyzed the time between 9-1-1 dispatches, the first dose of epinephrine and survival to hospital discharge. Methods: A retrospective analysis of prospectively collected statewide OHCA data using the SHARE database between October 2004 and December 2013. Results: There were 2,213 OHCA with a shockable initial rhythm who received epinephrine by EMS. Logistic regression was performed adjusted for age, gender, witnessed, bystander CPR, arrival time (dispatch to scene), and dispatch to defibrillation time, year, and method of ventilation. Of these, 396 (17.8%) survived to discharge. The times from dispatch to first epinephrine administration...
• Conover, Z., Kern, K. B., Silver, A. E., Bobrow, B. J., Spaite, D. W., & Indik, J. H. (2014). Resumption of chest compressions after successful defibrillation and risk for recurrence of ventricular fibrillation in out-of-hospital cardiac arrest. Circulation. Arrhythmia and electrophysiology, 7(4), 633-9.
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  Prior investigation of out-of-hospital cardiac arrest has raised the concern that ventricular fibrillation (VF) recurrence may be triggered by chest compression (CC) resumption. We investigated predictors of VF recurrence after defibrillation, including timing of CC resumption.
• Indik, J. H., Bobrow, B. J., Spaite, D. W., Silver, A., Mcgovern, M., Kern, K. B., Indik, J. H., Conover, Z., & Bobrow, B. J. (2014). Abstract 12769: Amplitude-Spectral Area of the Ventricular Fibrillation Waveform and Chest Compression Quality in Witnessed and Unwitnessed Out-Of-Hospital Cardiac Arrest: Can We Predict Who is Unlikely to Survive?. Circulation.
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  Background: Previous investigations in human out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) have shown that the frequency-based waveform characteristic, amplitude spectr...
• Indik, J. H., Conover, Z., Kern, K. B., Silver, A. E., Bobrow, B. J., & Spaite, D. W. (2014). Response to letter regarding, "resumption of chest compressions after successful defibrillation and risk for recurrence of ventricular fibrillation in out-of-hospital cardiac arrest". Circulation. Arrhythmia and electrophysiology, 7(6), 1278.
• Indik, J. H., Conover, Z., McGovern, M., Silver, A. E., Spaite, D. W., Bobrow, B. J., & Kern, K. B. (2014). Association of amplitude spectral area of the ventricular fibrillation waveform with survival of out-of-hospital ventricular fibrillation cardiac arrest. Journal of the American College of Cardiology, 64(13), 1362-9.
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  Previous investigations of out-of-hospital cardiac arrest (OHCA) have shown that the waveform characteristic amplitude spectral area (AMSA) can predict successful defibrillation and return of spontaneous circulation (ROSC) but has not been studied previously for survival.
• Moon, S., Bobrow, B. J., Vadeboncoeur, T. F., Kortuem, W., Kisakye, M., Sasson, C., Stolz, U., & Spaite, D. W. (2014). Disparities in bystander CPR provision and survival from out-of-hospital cardiac arrest according to neighborhood ethnicity. The American journal of emergency medicine, 32(9), 1041-5.
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  We aimed to determine if there are differences in bystander cardiopulmonary resuscitation (BCPR) provision and survival to hospital discharge from out-of-hospital cardiac arrest (OHCA) occurring in Hispanic neighborhoods in Arizona.
• Panchal, A. R., Meziab, O., Stolz, U., Anderson, W., Bartlett, M., Spaite, D. W., Bobrow, B. J., & Kern, K. B. (2014). The impact of ultra-brief chest compression-only CPR video training on responsiveness, compression rate, and hands-off time interval among bystanders in a shopping mall. Resuscitation, 85(9), 1287-90.
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  Recent studies have demonstrated higher-quality chest compressions (CCs) following a 60 s ultra-brief video (UBV) on compression-only CPR (CO-CPR). However, the effectiveness of UBVs as a CPR-teaching tool for lay bystanders in public venues remains unknown.
• Safdar, B., Stolz, U., Stiell, I. G., Cone, D. C., Bobrow, B. J., deBoehr, M., Dreyer, J., Maloney, J., & Spaite, D. W. (2014). Differential survival for men and women from out-of-hospital cardiac arrest varies by age: results from the OPALS study. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 21(12), 1503-11.
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  The effect of sex on survival in out-of-hospital cardiac arrest (OHCA) is controversial. Some studies report more favorable outcomes in women, while others suggest the opposite, citing disparities in care. Whether sex predicts differential age-specific survival is still uncertain.
• Spaite, D. W., Bobrow, B. J., Stolz, U., Berg, R. A., Sanders, A. B., Kern, K. B., Chikani, V., Humble, W., Mullins, T., Stapczynski, J. S., Ewy, G. A., & , A. C. (2014). Statewide regionalization of postarrest care for out-of-hospital cardiac arrest: association with survival and neurologic outcome. Annals of emergency medicine, 64(5), 496-506.e1.
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  For out-of-hospital cardiac arrest, authoritative, evidence-based recommendations have been made for regionalization of postarrest care. However, system-wide implementation of these guidelines has not been evaluated. Our hypothesis is that statewide regionalization of postarrest interventions, combined with emergency medical services (EMS) triage bypass, is associated with improved survival and neurologic outcome.
• Spaite, D. W., Bobrow, B. J., Stolz, U., Sherrill, D., Chikani, V., Barnhart, B., Sotelo, M., Gaither, J. B., Viscusi, C., Adelson, P. D., & Denninghoff, K. R. (2014). Evaluation of the impact of implementing the emergency medical services traumatic brain injury guidelines in Arizona: the Excellence in Prehospital Injury Care (EPIC) study methodology. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 21(7), 818-30.
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  Traumatic brain injury (TBI) exacts a great toll on society. Fortunately, there is growing evidence that the management of TBI in the early minutes after injury may significantly reduce morbidity and mortality. In response, evidence-based prehospital and in-hospital TBI treatment guidelines have been established by authoritative bodies. However, no large studies have yet evaluated the effectiveness of implementing these guidelines in the prehospital setting. This article describes the background, design, implementation, emergency medical services (EMS) treatment protocols, and statistical analysis of a prospective, controlled (before/after), statewide study designed to evaluate the effect of implementing the EMS TBI guidelines-the Excellence in Prehospital Injury Care (EPIC) study (NIH/NINDS R01NS071049, "EPIC"; and 3R01NS071049-S1, "EPIC4Kids"). The specific aim of the study is to test the hypothesis that statewide implementation of the international adult and pediatric EMS TBI guidelines will significantly reduce mortality and improve nonmortality outcomes in patients with moderate or severe TBI. Furthermore, it will specifically evaluate the effect of guideline implementation on outcomes in the subgroup of patients who are intubated in the field. Over the course of the entire study (~9 years), it is estimated that approximately 25,000 patients will be enrolled.
• Spaite, D. W., Kern, K. B., Indik, J. H., Conover, Z., Silver, A. E., & Bobrow, B. J. (2014). Response to Letter Regarding, “Resumption of Chest Compressions After Successful Defibrillation and Risk for Recurrence of Ventricular Fibrillation in Out-of-Hospital Cardiac Arrest”. Circulation: Arrhythmia and Electrophysiology, 7(6), 1278-1278. doi:10.1161/circep.114.002340
• Spaite, D. W., Stolz, U., Safdar, B., Stiell, I. G., Cone, D. C., Bobrow, B. J., deBoehr, M., Dreyer, J., & Maloney, J. (2014). Differential Survival for Men and Women from Out-of-hospital Cardiac Arrest Varies by Age: Results from the OPALS Study. Academic Emergency Medicine, 21(12), 1503-1511. doi:10.1111/acem.12540
• Stolz, U., Bobrow, B. J., Stolz, U., Spaite, D. W., Silver, A., Ryoo, H. W., Mcdannold, R., Jaber, J., Irisawa, T., & Bobrow, B. J. (2014). Abstract 295: Time in CPR Is Significantly Related to CPR Quality and Survival. Circulation, 130.
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  Background: Total CPR time and CPR quality are both believed to be associated with survival; however the exact relationship is unclear. Objectives: To assess the relationship between time in CPR an...
• Stolz, U., Bobrow, B. J., Vadeboncoeur, T. F., Tully, J., Stolz, U., Spaite, D. W., Panczyk, M., Murphy, R. A., Dunham, A., Dameff, C., Chikani, V., & Bobrow, B. J. (2014). A standardized template for measuring and reporting telephone pre-arrival cardiopulmonary resuscitation instructions.. Resuscitation, 85(7), 869-73. doi:10.1016/j.resuscitation.2014.02.023
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  Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. Telephone CPR (TCPR) comprises CPR instruction given by emergency dispatchers to bystanders responding to OHCA and the CPR performed as a result. TCPR instructions improve bystander CPR rates, but the quality of the instructions varies widely. No standardized system exists to critically evaluate the TCPR intervention..Investigators analyzed audio recordings of suspected OHCA calls from a large regional 9-1-1 dispatch center and applied descriptive terms, a data collection tool and a six metric reporting template to describe TCPR. Data were obtained from October 2010 to November 2011. Dispatcher recognition of CPR need, delivery of TCPR instructions, and bystander CPR performance were documented..A total of 590 calls were analyzed. Call evaluators achieved "near perfect agreement" with 5/6 reporting metrics and "strong agreement" on the 6th metric: percentage of calls where need for CPR was recognized by dispatch. CPR was indicated in 317 calls and already in progress in 94. Dispatchers recognized the need for TCPR in 176 of the 223 (79%) remaining calls. CPR instructions were started in 65/223 (29%) and bystander CPR resulting from TCPR instructions was started in 31/223 (14%)..We developed and demonstrated successful implementation of a simple data collection and reporting system for critical evaluation of the TCPR intervention. A standardized methodology for measuring TCPR is necessary to perform on-going quality improvement, to establish performance standards, and for future research on how to optimize bystander CPR rates and OHCA survival.
• Stolz, U., Bobrow, B. J., Viscusi, C., Stolz, U., Spaite, D. W., Sotelo, M., Sherrill, D. L., Mullins, T., Humble, W., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2014). Abstract 4: The Effect of Prehospital Hypoxia and Hypotension on Outcome in Major Traumatic Brain Injury: A Deadly Combination. Circulation, 130.
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  BACKGROUND: Hypoxia (HOx) or hypotension (HT) occurring during the EMS management of major traumatic brain injury-TBI reduces survival. However, little is known about the impact of both HOx and HT, occurring together, on outcome. Only a handful of reports have studied the combination of prehospital HOx/HT in TBI and the largest of these only had 14 cases with both. Objectives: To evaluate the associations between mortality and prehospital HOx and HT, both separately and in combination. METHODS: All moderate/severe TBI cases (CDC Barell Matrix Type-1) in the Excellence in Prehospital Injury Care (EPIC) TBI Study (a statewide, before/after controlled study of the impact of implementing the EMS TBI Treatment Guidelines-NIH/NINDS: 1R01NS071049) from 1/1/08-6/30/12 were evaluated [exclusions: age
• Stolz, U., Stolz, U., Spaite, D. W., & Bobrow, B. J. (2014). In reply.. Annals of emergency medicine, 63(2), 270-1. doi:10.1016/j.annemergmed.2013.09.010
• Stolz, U., Stolz, U., Spaite, D. W., Sakles, J. J., Mosier, J., Gaither, J. B., & Ennis, J. (2014). Prevalence of difficult airway predictors in cases of failed prehospital endotracheal intubation.. The Journal of emergency medicine, 47(3), 294-300. doi:10.1016/j.jemermed.2014.04.021
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  Difficult airway predictors (DAPs) are associated with failed endotracheal intubation (ETI) in the emergency department (ED). However, little is known about the relationship between DAPs and failed prehospital ETI..Our aim was to determine the prevalence of common DAPs among failed prehospital intubations..We reviewed a quality-improvement database, including all cases of ETI in a single ED, over 3 years. Failed prehospital (FP) ETI was defined as a case brought to the ED after attempted prehospital ETI, but bag-valve-mask ventilation, need for a rescue airway (supraglottic device, cricothyrotomy, etc.), or esophageal intubation was discovered at the ED. Physicians performing ETI evaluated each case for the presence of DAPs, including blood/emesis, facial/neck trauma, airway edema, spinal immobilization, short neck, and tongue enlargement..There were a total of 1377 ED ETIs and 161 had an FP-ETI (11.8%). Prevalence of DAPs in cases with FP-ETI was obesity 13.0%, large tongue 18.0%, short neck 13%, small mandible 4.3%, cervical immobility 49.7%, blood in airway 57.8%, vomitus in airway 23.0%, airway edema 12.4%, and facial or neck trauma 32.9%. The number of cases with FP-ETI and 0, 1, 2, 3, or 4 or more DAPs per case was 22 (13.6%), 43 (26.7%), 23 (24.3%), 42 (26.1%), and 31 (19.3%), respectively..DAPs are common in cases of FP-ETI. Some of these factors may be associated with FP-ETI. Additional study is needed to determine if DAPs can be used to identify patients that are difficult to intubate in the field.
• Vadeboncoeur, T., Stolz, U., Panchal, A., Silver, A., Venuti, M., Tobin, J., Smith, G., Nunez, M., Karamooz, M., Spaite, D., & Bobrow, B. (2014). Chest compression depth and survival in out-of-hospital cardiac arrest. Resuscitation, 85(2), 182-8.
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  Outcomes from out-of-hospital cardiac arrest (OHCA) may improve if rescuers perform chest compressions (CCs) deeper than the previous recommendation of 38-51mm and consistent with the 2010 AHA Guideline recommendation of at least 51mm. The aim of this study was to assess the relationship between CC depth and OHCA survival.
• Viscusi, C., Gaither, J. B., Barnhart, B., Sherrill, D., Bobrow, B. J., Spaite, D. W., Stolz, U., Chikani, V., Sotelo, M., Adelson, P. D., & Denninghoff, K. R. (2014). Evaluation of the Impact of Implementing the Emergency Medical Services Traumatic Brain Injury Guidelines in Arizona: The Excellence in Prehospital Injury Care (EPIC) Study Methodology. Academic Emergency Medicine, 21(7), 818-830. doi:10.1111/acem.12411
• Wright, J. L., Weik, T. S., Thomas, S. H., Spaite, D. W., Sahni, R., Oliver, Z. J., Lawner, B. J., Lang, E. S., Falck-ytter, Y., & Brown, K. M. (2014). An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 18 Suppl 1(sup1), 35-44. doi:10.3109/10903127.2013.844872
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  Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport..The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation..A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council..Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local adaptation..Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.
• Zaleski, E., Spaite, D., Silbergleit, R., Mcmullan, J. T., Jones, E., Denninghoff, K., & Barnhart, B. (2014). Degradation of benzodiazepines after 120 days of EMS deployment.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 18(3), 368-74. doi:10.3109/10903127.2013.869642
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  EMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures..To describe the degradation of diazepam, lorazepam, and midazolam as a function of temperature exposure and time over 120 days of storage on active EMS units..Study boxes containing vials of diazepam, lorazepam, and midazolam were distributed to 4 active EMS units in each of 2 EMS systems in the southwestern United States during May-August 2011. The boxes logged temperature every minute and were stored in EMS units per local agency policy. Two vials of each drug were removed from each box at 30-day intervals and underwent high-performance liquid chromatography to determine drug concentration. Concentration was analyzed as mean (and 95%CI) percent of initial labeled concentration as a function of time and mean kinetic temperature (MKT)..192 samples were collected (2 samples of each drug from each of 4 units per city at 4 time-points). After 120 days, the mean relative concentration (95%CI) of diazepam was 97.0% (95.7-98.2%) and of midazolam was 99.0% (97.7-100.2%). Lorazepam experienced modest degradation by 60 days (95.6% [91.6-99.5%]) and substantial degradation at 90 days (90.3% [85.2-95.4%]) and 120 days (86.5% [80.7-92.3%]). Mean MKT was 31.6°C (95%CI 27.1-36.1). Increasing MKT was associated with greater degradation of lorazepam, but not midazolam or diazepam..Midazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.
• Bobrow, B. J., Spaite, D. W., Helfenbein, E., Haro, G., Daya, M., Bobrow, B. J., Barnhart, B. J., & Babaeizadeh, S. (2013). Abstract 140: Comparison of CPR Quality Metrics Before and After Placement of Advanced Airways in Out-of-Hospital Cardiac Arrest. Circulation, 128.
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  Background: The value and role of advanced airway placement (AAP) (tracheal intubation and supraglottic airways) during out-of-hospital cardiac arrest (OHCA) is debatable and little is known about ...
• Bobrow, B. J., Spaite, D. W., Silver, A., Mcgovern, M., Kern, K. B., Indik, J. H., Conover, Z., & Bobrow, B. J. (2013). Abstract 10855: Amplitude-Spectral Area is Associated With Survival From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest. Circulation, 128.
• Bobrow, B. J., Spaite, D. W., Silver, A., Nunez, M., Mcdannold, R., Kassel, D., Karamooz, M., Heagerty, N., Dunham, A., & Bobrow, B. J. (2013). Abstract 15: The Accuracy of Prehospital Provider Oxygen Saturation and End-Tidal C02 Documentation in Severe Traumatic Brain Injury. Circulation, 128.
• Bobrow, B. J., Stolz, U., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Sanders, A. B., Panchal, A. R., Kern, K. B., Ewy, G. A., Bobrow, B. J., & Berg, R. A. (2013). Chest compression-only cardiopulmonary resuscitation performed by lay rescuers for adult out-of-hospital cardiac arrest due to non-cardiac aetiologies.. Resuscitation, 84(4), 435-9. doi:10.1016/j.resuscitation.2012.07.038
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  Bystander CPR improves survival in patients with out-of-hospital cardiac arrest (OHCA). For adult sudden collapse, bystander chest compression-only CPR (COCPR) is recommended in some circumstances by the American Heart Association and European Resuscitation Council. However, adults who arrest from non-cardiac causes may also receive COCPR. Because rescue breathing may be more important for individuals suffering OHCA secondary to non-cardiac causes, COCPR is not recommended for these cases. We evaluated the relationship of lay rescuer COCPR and survival after OHCA from non-cardiac causes..Analysis of a statewide Utstein-style registry of adult OHCA, during a large scale campaign endorsing COCPR for OHCA from presumed cardiac cause. The relationship between lay rescuer CPR (both conventional CPR and COCPR) and survival to hospital discharge was evaluated..Presumed non-cardiac aetiologies of OHCA accounted for 15% of all cases, and lay rescuer CPR was provided in 29% of these cases. Survival to hospital discharge occurred in 3.8% after conventional CPR, 2.7% after COCPR, and 4.0% after no CPR (p=0.85). The proportion of patients receiving COCPR was much lower in the cohort of OHCA from respiratory causes (8.3%) than for those with presumed cardiac OHCA (18.0%; p
• Bobrow, B. J., Stolz, U., Vadeboncoeur, T. F., Tobin, J. M., Stolz, U., Spaite, D. W., Smith, G. A., Silver, A. E., Schirmer, J., Mason, T. K., Crawford, S. A., & Bobrow, B. J. (2013). The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest.. Annals of emergency medicine, 62(1), 47-56.e1. doi:10.1016/j.annemergmed.2012.12.020
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  We assess whether an initiative to optimize out-of-hospital provider cardiopulmonary resuscitation (CPR) quality is associated with improved CPR quality and increased survival from out-of-hospital cardiac arrest..This was a before-after study of consecutive adult out-of-hospital cardiac arrest. Data were obtained from out-of-hospital forms and defibrillators. Phase 1 included 18 months with real-time audiovisual feedback disabled (October 2008 to March 2010). Phase 2 included 16 months (May 2010 to September 2011) after scenario-based training of 373 professional rescuers and real-time audiovisual feedback enabled. The effect of interventions on survival to hospital discharge was assessed with multivariable logistic regression. Multiple imputation of missing data was used to analyze the effect of interventions on CPR quality..Analysis included 484 out-of-hospital cardiac arrest patients (phase 1 232; phase 2 252). Median age was 68 years (interquartile range 56-79); 66.5% were men. CPR quality measures improved significantly from phase 1 to phase 2: Mean chest compression rate decreased from 128 to 106 chest compressions per minute (difference -23 chest compressions; 95% confidence interval [CI] -26 to -19 chest compressions); mean chest compression depth increased from 1.78 to 2.15 inches (difference 0.38 inches; 95% CI 0.28 to 0.47 inches); median chest compression fraction increased from 66.2% to 83.7% (difference 17.6%; 95% CI 15.0% to 20.1%); median preshock pause decreased from 26.9 to 15.5 seconds (difference -11.4 seconds; 95% CI -15.7 to -7.2 seconds), and mean ventilation rate decreased from 11.7 to 9.5/minute (difference -2.2/minute; 95% CI -3.9 to -0.5/minute). All-rhythms survival increased from phase 1 to phase 2 (20/231, 8.7% versus 35/252, 13.9%; difference 5.2%; 95% CI -0.4% to 10.8%), with an adjusted odds ratio of 2.72 (95% CI 1.15 to 6.41), controlling for initial rhythm, witnessed arrest, age, minimally interrupted cardiac resuscitation protocol compliance, and provision of therapeutic hypothermia. Witnessed arrests/shockable rhythms survival was 26.3% (15/57) for phase 1 and 55.6% (20/36) for phase 2 (difference 29.2%; 95% CI 9.4% to 49.1%)..Implementation of resuscitation training combined with real-time audiovisual feedback was independently associated with improved CPR quality, an increase in survival, and favorable functional outcomes after out-of-hospital cardiac arrest.
• Bobrow, B. J., Stolz, U., Vadeboncoeur, T. F., Tully, J., Stolz, U., Spaite, D. W., Panczyk, M., Murphy, R. A., Heagerty, N., Dameff, C., & Bobrow, B. J. (2013). Abstract 81: The Impact of Pre-Arrival Dispatch-Assisted CPR on Bystander CPR Rates, Time to Starting CPR and Survival From Out-of-Hospital Cardiac Arrest. Circulation, 128.
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  Background: Bystander CPR (BCPR) strongly influences survival from OHCA yet is provided in a minority of cases. The AHA has promulgated guidelines on provision of pre-arrival Hands-Only dispatcher-...
• Bobrow, B. J., Venuti, M., Vadeboncoeur, T. F., Spaite, D. W., Smith, G., Silver, A., Roosa, J. R., Panchal, A. R., Mullins, M., Dommer, P. B., & Bobrow, B. J. (2013). CPR variability during ground ambulance transport of patients in cardiac arrest.. Resuscitation, 84(5), 592-5. doi:10.1016/j.resuscitation.2012.07.042
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  High-quality CPR is associated with improved outcomes from out-of-hospital cardiac arrest (OHCA). The purpose of this investigation was to compare the quality of CPR provided at the prehospital scene, during ambulance transport, and during the early minutes in the emergency department (ED)..A prospective observational review of consecutive adult patients with non-traumatic OHCA was conducted between September 2008 and February 2010. Patients with initiation of prehospital CPR were included as part of a statewide cardiac resuscitation quality improvement program. A monitor-defibrillator with accelerometer-based CPR measurement capability (E-series, ZOLL Medical) was utilized. CPR quality measures included variability in chest compression (CC) depth and rate, mean depth and rate, and the CC fraction. Variability of CC was defined as the mean of minute-to-minute standard deviation in CC depth or rate. CC fraction was defined as the percent of time that CPR was being performed when appropriate throughout resuscitation..Fifty-seven adult patients with OHCA had electronic CPR data recorded at the scene, in the ambulance, and upon arrival in the ED. Across time periods, there was increased variability in CC depth (scene: 0.20 in.; transport: 0.26 in.; ED: 0.31 in., P
• Bobrow, B. J., Venuti, M., Vadeboncoeur, T. F., Tobin, J. R., Spaite, D. W., Silver, A., Murphy, R. A., Moon, S., Karamooz, M., & Bobrow, B. J. (2013). Abstract 306: Use of Real-Time Audiovisual CPR Feedback is Associated With Improved CPR Quality During Patient Transfer From the Scene to the Ambulance in Out-of-Hospital Cardiac Arrest. Circulation, 128.
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  Background: In the simulation setting, chest compression (CC) quality is reduced when out-of-hospital cardiac arrest “patients” are prepared for transport (i.e. packaged and moved to ambulance). It...
• Bobrow, B. J., Venuti, M., Vadeboncoeur, T. F., Tobin, J., Spaite, D. W., Smith, G. B., Silver, A., Mullins, M., & Bobrow, B. J. (2013). Chest compression quality declines in the minutes preceding scene departure in out-of-hospital cardiac arrest. Resuscitation, 84, S27. doi:10.1016/j.resuscitation.2013.08.080
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• Bobrow, B. J., White, B., Spaite, D. W., Moon, S., Kortuem, W., Kisakye, M., Karamooz, M., Hwang, S. S., & Bobrow, B. J. (2013). Abstract 103: Analysis of Out-of-Hospital Cardiac Arrest Location and Public Access Defibrillator Placement in Metro Phoenix, Arizona. Circulation, 128.
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  Background and Objective: Automated external defibrillators (AEDs) improve outcomes from out-of-hospital cardiac arrest (OHCA) but are infrequently used. We sought to compare the locations of OHCAs...
• Bobrow, B. J., White, B., Vadeboncoeur, T. F., Spaite, D. W., Shin, S., Moon, S., Martinez, R., Kortuem, W., Kisakye, M., & Bobrow, B. J. (2013). Abstract 283: Disparities in Bystander CPR and Neurologic Outcomes From Cardiac Arrest According to Neighborhood Ethnicity Characteristics in Arizona. Circulation, 128.
• Stolz, U., Bobrow, B. J., Stolz, U., Spaite, D. W., Panchal, A. R., Meziab, O., Kern, K. B., Bobrow, B. J., Bartlett, M. J., & Anderson, W. (2013). Abstract 157: Randomized Controlled Trial of the Impact of Ultra-Brief Chest Compression-Only CPR Video Training on Responsiveness, Compression Rate, and Hands-Off Time Interval Among Bystanders in a Shopping Mall. Circulation, 128.
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  Background: Recent studies have demonstrated higher quality chest compressions (CCs) following a 60 sec ultra-brief video (UBV) on compression-only CPR (CO-CPR). However, the effectiveness of UBVs as a CPR teaching tool for lay bystanders in public venues remains unknown. Objective: Determine whether: 1) UBV is an effective instrument to teach laypersons CO-CPR in a public setting and 2) viewing leads to superior responsiveness and CPR skills in simulated arrest scenarios versus untrained controls. Methods: Study setting was a shopping mall. Adult (age ≥18) bystanders with no CPR training in the last 24 months were enrolled and randomized into two arms: (1) Control (CTR): sat idle for 60 sec; (2) UBV: watched a 60 sec UBV on CO-CPR. Subjects were taken to a private area where a Laerdal Skillreporter™ mannequin was on the ground and read a simulated scenario detailing a sudden collapse in the mall and asked to do what they “thought was best”. Performance measures were recorded for 2 min: responsiveness (ti...
• Stolz, U., Bobrow, B. J., Sutter, J., Stolz, U., Spaite, D. W., Nunez, M., Mullins, T., Mullins, M., Karamooz, M., Heagerty, N., Chikani, V., & Bobrow, B. J. (2013). Abstract 100: Length of Coma in Out-of-Hospital Cardiac Arrest Survivors Treated With Mild Therapeutic Hypothermia. Circulation, 128.
• Stolz, U., Bobrow, B. J., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Silver, A., Lovecchio, F., Hefner, M., Crowe, C., Bronnenkant, T., & Bobrow, B. J. (2013). Abstract 268: Improvements in Emergency Department CPR Quality Utilizing Real-Time Audiovisual CPR Feedback. Circulation, 128.
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  Background: CPR quality is closely linked to outcome in cardiac arrest. The AHA 2010 Guidelines recommend monitoring CPR quality performed by healthcare providers both inside and outside the hospital. However, most EDs currently do not monitor CPR quality. The goal of the present investigation was to assess the quality of CPR performed in an urban ED and determine the influence of training and real-time audiovisual feedback (RTAVF) on CPR quality and patient outcome. Methods: CPR quality was monitored using an R Series defibrillator (ZOLL Medical) during the treatment of adult cardiac resuscitation attempts. During phase 1 (P1; 11/2010-11/2012), real-time audiovisual chest compression feedback was disabled. During phase 2 (P2; 11/2012-3/2013), clinicians underwent a 60 minute didactic/hands-on CPR training session after which the RTAVF and the ECG artifact filtering feature were enabled. CPR quality data (fraction, depth, rate, release, peri-shock pause) were reviewed using Code Review software (ZOLL Medi...
• Stolz, U., Bobrow, B. J., Venturi, M., Vadeboncoeur, T. F., Tobin, J., Stolz, U., Spaite, D. W., Smith, G., Silver, A., Panchal, A. R., Nunez, M., & Bobrow, B. J. (2013). Increased Chest Compression Depth is Associated With Improved Survival from Out-of-Hospital Cardiac Arrest. Annals of Emergency Medicine, 62(4), S140-S141. doi:10.1016/j.annemergmed.2013.07.219
• Zaleski, E. Z., Spaite, D. W., Silbergleit, R., Siewart, N., Pinnawin, A., Mcmullan, J. T., Jones, E. B., & Denninghoff, K. R. (2013). The 60-day temperature-dependent degradation of midazolam and Lorazepam in the prehospital environment.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 17(1), 1-7. doi:10.3109/10903127.2012.722177
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  The choice of the optimal benzodiazepine to treat prehospital status epilepticus is unclear. Lorazepam is preferred in the emergency department, but concerns about nonrefrigerated storage limits emergency medical services (EMS) use. Midazolam is increasingly popular, but its heat stability is undocumented..This study evaluated temperature-dependent degradation of lorazepam and midazolam after 60 days in the EMS environment..Lorazepam or midazolam samples were collected prior to (n = 139) or after (n = 229) 60 days of EMS deployment during spring-summer months in 14 metropolitan areas across the United States. Medications were stored in study boxes that logged temperature every minute and were stored in EMS units per local agency policy. Mean kinetic temperature (MKT) exposure was derived for each sample. Drug concentrations were determined in a central laboratory by high-performance liquid chromatography. Concentration as a function of MKT was analyzed by linear regression..Prior to deployment, measured concentrations of both benzodiazepines were 1.0 relative to labeled concentration. After 60 days, midazolam showed no degradation (mean relative concentration 1.00, 95% confidence interval [CI] 1.00-1.00) and was stable across temperature exposures (adjusted R(2) -0.008). Lorazepam experienced little degradation (mean relative concentration 0.99, 95% CI 0.98-0.99), but degradation was correlated to increasing MKT (adjusted R(2) 0.278). The difference between the temperature dependence of degradation of midazolam and lorazepam was statistically significant (T = -5.172, p < 0.001)..Lorazepam experiences small but statistically significant temperature-dependent degradation after 60 days in the EMS environment. Additional study is needed to evaluate whether clinically significant deterioration occurs after 60 days. Midazolam shows no degradation over this duration, even in high-heat conditions.
• Bobrow, B. J., Stolz, U., Meislin, H. W., Stolz, U., Spaite, D. W., Meislin, H. W., Gaither, J. B., Denninghoff, K. R., Bobrow, B. J., & Beskind, D. L. (2012). Balancing the potential risks and benefits of out-of-hospital intubation in traumatic brain injury: the intubation/hyperventilation effect.. Annals of emergency medicine, 60(6), 732-6. doi:10.1016/j.annemergmed.2012.06.017
• Bobrow, B. J., Stolz, U., Stolz, U., Stapczynski, J. S., Spaite, D. W., Mullins, T., Mullins, M., Kern, K. B., Humble, W., Ewy, G. A., Chikani, V., & Bobrow, B. J. (2012). System-wide Regionalization of EMS and Hospital Care for Out-of-Hospital Cardiac Arrest: Association with Improved Survival and Neurologic Outcomes. Resuscitation, 83, e19. doi:10.1016/j.resuscitation.2012.08.048
• Bobrow, B. J., Stolz, U., Zhang, J., Stolz, U., Spaite, D. W., Sayre, M. R., Sasson, C., Rea, T. D., Mcnally, B., Denninghoff, K. R., Cudnik, M. T., & Bobrow, B. J. (2012). Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology.. Resuscitation, 83(7), 862-8. doi:10.1016/j.resuscitation.2012.02.006
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  Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA)..This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year≤10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed..The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35% among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100%). Unadjusted survival did not differ between the 3 hospital groups (36% for ≤10 OHCA/year, 35% for 11-39, and 36% for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI(95) 0.83-1.28) among 11-39 annual volume and 0.97 (CI(95) 0.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups..Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.
• Bobrow, B. J., Wasick, D., Tully, J., Spaite, D. W., Panczyk, M., Murphy, R. A., Dunham, A., Dameff, C., & Bobrow, B. J. (2012). Abstract 274: Primary Reasons Bystanders Do Not Perform CPR When Receiving Dispatcher Instructions. Circulation, 126.
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  Introduction: Dispatch-Assisted CPR (DACPR) has been shown to be an effective method of increasing bystander CPR (BCPR) rates and survival from out-of-hospital cardiac arrest (OHCA). Objective: No quantitative studies have specifically assessed why bystanders fail to perform CPR when offered pre-arrival CPR instructions from a dispatcher. We identified common reasons bystanders do not perform CPR when 9-1-1 emergency dispatchers offer CPR instructions. Methods: Review of suspected OHCA audio recordings from 3 regional 9-1-1 emergency dispatch centers for calls in which dispatchers offered CPR instructions. This study evaluated the subset where callers either verbally refused or were unable to perform CPR. The reasons for refusal or inability to perform CPR were categorized and recorded on a structured data form. Results: 555 total audio files between 04/11-01/12 were identified based upon dispatch center suspicion of OHCA. Upon review of calls, cases were excluded if: CPR was not indicated (111/555, 20.0%), CPR was already in progress (60/555; 10.8%), bystanders believed the victim to be deceased (59/555, 10.6%), audio was not clear (20/555, 3.6%), caller was not with victim (18/555, 3.2%) or EMS arrived before DACPR could be initiated (13/555, 2.3%). Bystanders performed CPR per dispatch instructions in 30.1% of cases (167/555). In the remaining cases (107/555, 19.3%; study group), BCPR was not performed because bystanders were either unwilling to perform CPR (58/107, 54.2%) or unable to attempt CPR (49/107, 45.8%). Conclusion: There are multiple reasons bystanders do not perform CPR, even when dispatcher instructions are offered. In this study, inability to move the arrest victim, fear of causing harm, and panic were the predominant reasons CPR was not initiated. An assertive dispatcher can help overcome these barriers.
• Spaite, D. W., Sheahan, W. D., Nichol, G., Maio, R. F., Lookman, H. A., Lerner, E. B., Ginster, A. M., Garrison, H. G., Franz, T. R., & Austad, J. D. (2012). An economic toolkit for identifying the cost of emergency medical services (EMS) systems: detailed methodology of the EMS Cost Analysis Project (EMSCAP).. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 19(2), 210-6. doi:10.1111/j.1553-2712.2011.01277.x
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  Calculating the cost of an emergency medical services (EMS) system using a standardized method is important for determining the value of EMS. This article describes the development of a methodology for calculating the cost of an EMS system to its community. This includes a tool for calculating the cost of EMS (the "cost workbook") and detailed directions for determining cost (the "cost guide"). The 12-step process that was developed is consistent with current theories of health economics, applicable to prehospital care, flexible enough to be used in varying sizes and types of EMS systems, and comprehensive enough to provide meaningful conclusions. It was developed by an expert panel (the EMS Cost Analysis Project [EMSCAP] investigator team) in an iterative process that included pilot testing the process in three diverse communities. The iterative process allowed ongoing modification of the toolkit during the development phase, based upon direct, practical, ongoing interaction with the EMS systems that were using the toolkit. The resulting methodology estimates EMS system costs within a user-defined community, allowing either the number of patients treated or the estimated number of lives saved by EMS to be assessed in light of the cost of those efforts. Much controversy exists about the cost of EMS and whether the resources spent for this purpose are justified. However, the existence of a validated toolkit that provides a standardized process will allow meaningful assessments and comparisons to be made and will supply objective information to inform EMS and community officials who are tasked with determining the utilization of scarce societal resources.
• Stolz, U., Bobrow, B. J., Tobin, J., Stolz, U., Spaite, D. W., Silver, A., Murphy, R. A., Mullins, T., Karamooz, M., Ewy, G. A., & Bobrow, B. J. (2012). Correlations Between CPR Quality Metrics and End-Tidal CO2 in Out-of-Hospital Cardiac Arrest. Resuscitation, 83, e9. doi:10.1016/j.resuscitation.2012.08.024
• Stolz, U., Bobrow, B. J., Tully, J., Tobin, J. R., Stolz, U., Spaite, D. W., Panczyk, M., Murphy, R. A., Karamooz, M., Ewy, G. A., Dunham, A., Dameff, C., & Bobrow, B. J. (2012). Abstract 247: The Impact of the AHA Guidelines on Dispatch-Assisted Cardiopulmonary Resuscitation. Circulation, 126.
• Stolz, U., Bobrow, B. J., Tully, J., Tobin, J. R., Stolz, U., Spaite, D. W., Panczyk, M., Murphy, R. A., Kotsur, B., Karamooz, M., Dunham, A., Dameff, C., & Bobrow, B. J. (2012). Abstract 242: A Standardized Template for Measuring and Reporting Dispatch Prearrival CPR. Circulation, 126.
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  Introduction: Dispatch-Assisted CPR (DACPR) is a method for improving bystander response and survival from out-of-hospital cardiac arrest (OHCA). No standardized methodology exists for measuring an...
• Stolz, U., Bobrow, B. J., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Silver, A., Roque, P., Roosa, J., Page, R., Mccarty, K., Kitamura, B., & Bobrow, B. J. (2012). Abstract 281: Does Chest Compression-Only CPR Provide Meaningful Gas Exchange in Humans?. Circulation, 126.
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  Background: During CPR in animals, chest compressions (CC) may produce passive volumes large enough to provide adequate ventilation. In humans, this mechanism may explain why continuous CCs have be...
• Stolz, U., Bobrow, B. J., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Silver, A., Roque, P., Roosa, J., Page, R., Mccarty, K., Kitamura, B., & Bobrow, B. J. (2012). Ventilation rates and tidal volume during emergency department cardiac resuscitation. Resuscitation, 83, e45. doi:10.1016/j.resuscitation.2012.08.114
• Stolz, U., Bobrow, B. J., Venuti, M., Vadeboncoeur, T. F., Tobin, J. R., Stolz, U., Spaite, D. W., Silver, A., Roque, P., Murphy, R. A., Karmooz, M., & Bobrow, B. J. (2012). Abstract 135: The Association of Preshock Pause and Survival from Out-of-Hospital Cardiac Arrest. Circulation, 126.
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  Objective: Preshock pause (PSP_time from last chest compression [CC] to defibrillation) is believed to be an important component of CPR quality, but the relationship between PSP and survival is unknown. We sought to determine if a dedicated intervention to improve prehospital CPR quality and minimize PSPs would result in a shortened preshock interval and improve survival from out-of-hospital cardiac arrest (OHCA). Methods: Data were extracted from prehospital care reports and defibrillators (E Series, ZOLL) of 2 EMS agencies (combined population-500,000) participating in a CPR quality improvement program. Consecutive non-traumatic adult OHCA of presumed cardiac etiology were included. Phase 1 (P1): 19 months of baseline data with real-time audiovisual feedback (RTAVF) disabled (9/08-3/10). Interventions: 1) Scenario-based training of ∼450 EMTs, 2) RTAVF enabled, 3) activation of “Charging During Compressions” feature, 4) EMT post-code debriefings. Phase 2 (P2):16 months immediately following implementatio...
• Stolz, U., Bobrow, B. J., Welch, A., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Silver, A., Panchal, A. R., Nunez, M., Murphy, R. A., & Bobrow, B. J. (2012). Abstract 130: The Effect of CPR Quality on Survival and Neurological Outcome After Out-of-Hospital Cardiac Arrest. Circulation, 126.
• Stolz, U., Grall, K. H., Stoneking, L. R., Stolz, U., Spaite, D. W., Simpson, A., Panchal, A. R., Grall, K., Denninghoff, K. R., Deluca, L. A., & Beskind, D. L. (2012). Analysis of automated external defibrillator device failures reported to the Food and Drug Administration.. Annals of emergency medicine, 59(2), 103-11. doi:10.1016/j.annemergmed.2011.07.022
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  Automated external defibrillators are essential for treatment of cardiac arrest by lay rescuers and must determine when to shock and if they are functioning correctly. We seek to characterize automated external defibrillator failures reported to the Food and Drug Administration (FDA) and whether battery failures are properly detected by automated external defibrillators..FDA adverse event reports are catalogued in the Manufacturer and User Device Experience (MAUDE) database. We developed and internally validated an instrument for analyzing MAUDE data, reviewing all reports in which a fatality occurred. Two trained reviewers independently analyzed each report, and a third resolved discrepancies or passed them to a committee for resolution..One thousand two hundred eighty-four adverse events were reported between June 1993 and October 2008, of which 1,150 were failed defibrillation attempts. Thirty-seven automated external defibrillators never powered on, 252 failed to complete rhythm analysis, and 524 failed to deliver a recommended shock. In 149 cases, the operator disagreed with the device's rhythm analysis. In 54 cases, the defibrillator stated the batteries were low and in 110 other instances powered off unexpectedly. Interrater agreement between reviewers 1 and 2 ranged by question from 69.0% to 98.6% and for most likely cause was 55.9%. Agreement was obtained for 93.7% to 99.6% of questions by the third reviewer. Remaining discrepancies were resolved by the arbitration committee..MAUDE information is often incomplete and frequently no corroborating data are available. Some conditions not detected by automated external defibrillators during self-test cause units to power off unexpectedly, causing defibrillation delays. Backup units frequently provide shocks to patients.
• Swor, R. A., Spaite, D. W., Oliver, Z. J., Lang, E. S., Hunt, R. C., Gotschall, C. S., & Dawson, D. E. (2012). A national model for developing, implementing, and evaluating evidence-based guidelines for prehospital care.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 19(2), 201-9. doi:10.1111/j.1553-2712.2011.01281.x
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  In 2007, the Institute of Medicine's (IOM's) Committee on the Future of Emergency Care recommended that a multidisciplinary panel establish a model for developing evidence-based protocols for the treatment of emergency medical systems (EMS) patients. In response, the National EMS Advisory Council (NEMSAC) and the Federal Interagency Committee on EMS (FICEMS) convened a panel of multidisciplinary experts to review current strategies for developing evidence-based guidelines (EBGs) and to propose a model for developing such guidelines for the prehospital milieu. This paper describes the eight-step model endorsed by FICEMS, NEMSAC, and a panel of EMS and evidence-based medicine experts. According to the model, prehospital EBG development would begin with the input of evidence from various external sources. Potential EBG topics would be suggested following a preliminary evidentiary review; those topics with sufficient extant foundational evidence would be selected for development. Next, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology would be used to determine a quality-of-evidence rating and a strength of recommendation related to the patient care guidelines. More specific, contextualized patient care protocols would then be generated and disseminated to the EMS community. After educating EMS professionals using targeted teaching materials, the protocols would be implemented in local EMS systems. Finally, effectiveness and uptake would be measured with integrated quality improvement and outcomes monitoring systems. The constituencies and experts involved in the model development process concluded that the use of such transparent, objective, and scientifically rigorous guidelines could significantly increase the quality of EMS care in the future.
• Bobrow, B. J., Spaite, D. W., Rea, T. D., & Bobrow, B. J. (2011). Chest-compression-only versus standard CPR.. Lancet (London, England), 377(9767), 717; author reply 718-9. doi:10.1016/s0140-6736(11)60266-3
• Bobrow, B. J., Spaite, D. W., Silver, A., Roosa, J., Panchal, A. R., Page, R., Mccarty, K., Lovecchio, F., Kitamura, B., Dommer, P. B., & Bobrow, B. J. (2011). Abstract 218: CPR Quality in an Urban Teaching Hospital Emergency Department: Are 2010 AHA Guidelines Being Implemented?. Circulation, 124.
• Bobrow, B. J., Stolz, U., Stolz, U., Spaite, D. W., & Bobrow, B. J. (2011). Survival From Out-of-Hospital Cardiac Arrest After Chest Compression–Only CPR—Reply. JAMA, 305(2), 147-148. doi:10.1001/jama.2010.1953
• Bobrow, B. J., Stolz, U., Venuti, M., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Smith, G. B., Silver, A., Pyers, K., Panchal, A. R., Ewy, G. A., & Bobrow, B. J. (2011). Abstract 208: Achieving the 2010 AHA Guideline Metrics for CPR Quality Is Associated with Improved Survival from Out-of-Hospital Cardiac Arrest. Circulation, 124.
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Ramsey, B., Potts, J., Denninghoff, K. R., Chikani, V., Brazil, P. R., Bobrow, B. J., & Abella, B. S. (2011). The effectiveness of ultrabrief and brief educational videos for training lay responders in hands-only cardiopulmonary resuscitation: implications for the future of citizen cardiopulmonary resuscitation training.. Circulation. Cardiovascular quality and outcomes, 4(2), 220-6. doi:10.1161/circoutcomes.110.959353
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  Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but often is not performed. We hypothesized that subjects viewing very short Hands-Only CPR videos will (1) be more likely to attempt CPR in a simulated OHCA scenario and (2) demonstrate better CPR skills than untrained individuals..This study is a prospective trial of 336 adults without recent CPR training randomized into 4 groups: (1) control (no training) (n=51); (2) 60-second video training (n=95); (3) 5-minute video training (n=99); and (4) 8-minute video training, including manikin practice (n=91). All subjects were tested for their ability to perform CPR during an adult OHCA scenario using a CPR-sensing manikin and Laerdal PC SkillReporting software. One half of the trained subjects were randomly assigned to testing immediately and the other half after a 2-month delay. Twelve (23.5%) controls did not even attempt CPR, which was true of only 2 subjects (0.7%; P=0.01) from any of the experimental groups. All experimental groups had significantly higher average compression rates (closer to the recommended 100/min) than the control group (P38 mm) than the control group (P
• Spaite, D. W., Maio, R. F., Lerner, E. B., Keim, S. M., Howse, D., Garrison, H. G., & Beskind, D. L. (2011). Risk adjustment measures and outcome measures for prehospital trauma research: recommendations from the emergency medical services outcomes project (EMSOP).. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 18(9), 988-1000. doi:10.1111/j.1553-2712.2011.01148.x
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  The objectives were to conduct a comprehensive, systematic review of the literature for risk adjustment measures (RAMs) and outcome measures (OMs) for prehospital trauma research and to use a structured expert panel process to recommend measures for use in future emergency medical services (EMS) trauma outcomes research..A systematic literature search and review was performed identifying the published studies evaluating RAMs and OMs for prehospital injury research. An explicit structured review of all articles pertaining to each measure was conducted using the previously established methodology developed by the Canadian Physiotherapy Association ("Physical Rehabilitation Outcome Measures")..Among the 4,885 articles reviewed, 96 RAMs and/or OMs were identified from the existing literature (January 1958 to February 2010). Only one measure, the Glasgow Coma Scale (GCS), currently meets Level 1 quality of evidence status and a Category 1 (strong) recommendation for use in EMS trauma research. Twelve RAMs or OMs received Category 2 status (promising, but not sufficient current evidence to strongly recommend), including the motor component of GCS, simplified motor score (SMS), the simplified verbal score (SVS), the revised trauma score (RTS), the prehospital index (PHI), EMS provider judgment, the revised trauma index (RTI), the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the field trauma triage (FTT), the pediatric triage rule, and the out-of-hospital decision rule for pediatrics..Using a previously published process, a structured literature review, and consensus expert panel opinion, only the GCS can currently be firmly recommended as a specific RAM or OM for prehospital trauma research (along with core measures that have already been established and published). This effort highlights the paucity of reliable, validated RAMs and OMs currently available for outcomes research in the prehospital setting and hopefully will encourage additional, methodologically sound evaluations of the promising, Category 2 RAMs and OMs, as well as the development of new measures.
• Stolz, U., Bobrow, B. J., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Roosa, J., Panchal, A. R., Mullins, M., Ewy, G. A., Bobrow, B. J., & Berg, R. A. (2011). Abstract 164: Impact of an AHA Guideline-Based, Statewide Postarrest System of Care on Survival from Out-of-Hospital Cardiac Arrest. Circulation, 124.
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  BACKGROUND: The 2010 American Heart Association (AHA) Guidelines added integrated post-cardiac arrest care as a new 5th link in the classic chain of survival model. In this analysis we: 1) describe...
• Stolz, U., Bobrow, B. J., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Silver, A., Roosa, J., Panchal, A. R., Kern, K. B., Ewy, G. A., & Bobrow, B. J. (2011). Abstract 75: Body Weight-Related Adjustments to Chest Compression Depth by EMS Providers During Out-of-Hospital Cardiac Arrest. Circulation, 124.
• Stolz, U., Bobrow, B. J., Venuti, M., Stolz, U., Spaite, D. W., Smith, G. B., Silver, A., Pyers, K., Mullins, M., Kaufman, C. L., Ewy, G. A., & Bobrow, B. J. (2011). AS13 The association between end-tidal CO2 and CPR quality metrics in out-of-hospital cardiac arrest. Resuscitation, 82, S4. doi:10.1016/s0300-9572(11)70014-4
• Stolz, U., Bobrow, B. J., Welch, A., Vadeboncoeur, T. F., Stolz, U., Spaite, D. W., Sanders, A. B., Panchal, A. R., Kern, K. B., Ewy, G. A., Bobrow, B. J., & Berg, R. A. (2011). Abstract 64: Ability of Bystanders to Appropriately Provide Rescue Breathing in the Setting of a Chest Compression--Only CPR Campaign for Sudden Cardiac Arrest. Circulation, 124.
• Bobrow, B. J., Spaite, D. W., Renjilian, C., Mechem, C. C., Lerner, E. B., Kupas, D. F., Cone, D. C., Carter, A. J., Bobrow, B. J., & Band, R. A. (2010). Prehospital care and new models of regionalization.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(12), 1337-45. doi:10.1111/j.1553-2712.2010.00935.x
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  This article summarizes the discussions of the emergency medical services (EMS) breakout session at the June 2010 Academic Emergency Medicine consensus conference "Beyond Regionalization: Integrated Networks of Emergency Care." The group focused on prehospital issues such as the identification of patients by EMS personnel, protocol-driven destination selection, bypassing closer nondesignated centers to transport patients directly to more distant designated specialty centers, and the modes of transport to be used as they relate to the regionalization of emergency care. It is our hope that the proposed research agenda will be advanced in a way that begins to rigorously approach the unanswered research questions and that these answers, in turn, will lead to an evidence-based, cohesive, comprehensive, and more uniform set of guidelines that govern the delivery and practice of prehospital emergency care.
• Bobrow, B. J., Spaite, D. W., Roosa, J., Nichol, G., Mullins, M., Mccarty, K., Chikani, V., Bunis, J., & Bobrow, B. J. (2010). Abstract 232: Early Withdrawal of Post-Arrest Care After Therapeutic Hypothermia in Victims of Out-of-Hospital Cardiac Arrest. Circulation, 122.
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  Objective: Current guidelines state that neurologic prognosis after out-of-hospital cardiac arrest (OHCA) cannot be reliably assessed within 72 hours of the completion of therapeutic hypothermia (T...
• Bobrow, B. J., Stolz, U., Vadeboncoeur, T. F., Stolz, U., Stapczynski, J. S., Spaite, D. W., Sanders, A. B., Mullins, T. J., Lovecchio, F., Kern, K. B., Humble, W. O., Gallagher, J. V., Ewy, G. A., Clark, L. L., Bobrow, B. J., & Berg, R. A. (2010). Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest.. JAMA, 304(13), 1447-54. doi:10.1001/jama.2010.1392
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  Chest compression-only bystander cardiopulmonary resuscitation (CPR) may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest..To investigate the survival of patients with out-of-hospital cardiac arrest using compression-only CPR (COCPR) compared with conventional CPR..A 5-year prospective observational cohort study of survival in patients at least 18 years old with out-of-hospital cardiac arrest between January 1, 2005, and December 31, 2009, in Arizona. The relationship between layperson bystander CPR and survival to hospital discharge was evaluated using multivariable logistic regression..Survival to hospital discharge..Among 5272 adults with out-of-hospital cardiac arrest of cardiac etiology not observed by responding emergency medical personnel, 779 were excluded because bystander CPR was provided by a health care professional or the arrest occurred in a medical facility. A total of 4415 met all inclusion criteria for analysis, including 2900 who received no bystander CPR, 666 who received conventional CPR, and 849 who received COCPR. Rates of survival to hospital discharge were 5.2% (95% confidence interval [CI], 4.4%-6.0%) for the no bystander CPR group, 7.8% (95% CI, 5.8%-9.8%) for conventional CPR, and 13.3% (95% CI, 11.0%-15.6%) for COCPR. The adjusted odds ratio (AOR) for survival for conventional CPR vs no CPR was 0.99 (95% CI, 0.69-1.43), for COCPR vs no CPR, 1.59 (95% CI, 1.18-2.13), and for COCPR vs conventional CPR, 1.60 (95% CI, 1.08-2.35). From 2005 to 2009, lay rescuer CPR increased from 28.2% (95% CI, 24.6%-31.8%) to 39.9% (95% CI, 36.8%-42.9%; P < .001); the proportion of CPR that was COCPR increased from 19.6% (95% CI, 13.6%-25.7%) to 75.9% (95% CI, 71.7%-80.1%; P < .001). Overall survival increased from 3.7% (95% CI, 2.2%-5.2%) to 9.8% (95% CI, 8.0%-11.6%; P < .001)..Among patients with out-of-hospital cardiac arrest, layperson compression-only CPR was associated with increased survival compared with conventional CPR and no bystander CPR in this setting with public endorsement of chest compression-only CPR.
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Ramsey, B., Potts, J., Denninghoff, K. R., Chikani, V., Brazil, P. R., Bobrow, B. J., & Abella, B. S. (2010). Abstract 114: The Effectiveness of Ultra-Brief and Brief Educational Videos for Training Lay Responders in Hands-OnlyTM Cardiopulmonary Resuscitation: Implications for the Future of Citizen CPR Training. Circulation, 122.
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  Background: Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but is often not performed. Hypotheses: Subjects viewing very short Hands-Only...
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Ramsey, B., Potts, J., Denninghoff, K. R., Chikani, V., Brazil, P. R., Bobrow, B. J., & Abella, B. S. (2010). Impact of brief or ultra-brief Hands-Only CPR video training on the confidence of lay citizens to perform CPR. Resuscitation, 81(2), S96. doi:10.1016/j.resuscitation.2010.09.392
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Sanders, A. B., Roosa, J., Panchal, A. R., Kern, K. B., Geyer, B., & Bobrow, B. J. (2010). Abstract 44: Prevalence of Cardiac Catheterization and Outcomes From Out-of-Hospital Cardiac Arrest in a Consortium of Cardiac Receiving Centers. Circulation, 122.
• Stolz, U., Bobrow, B. J., Stolz, U., Spaite, D. W., Sanders, A. B., Panchal, A. R., Kern, K. B., Ewy, G. A., & Bobrow, B. J. (2010). Abstract 86: The Impact of Hands-OnlyTM CPR by Bystanders on Survival in Adult Victims of Out-of-Hospital Arrest Caused by Non-Cardiac Etiologies. Circulation, 122.
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  Introduction: The use of bystander CPR has demonstrated improved survival in patients with sudden, out of hospital cardiac arrest. Hands-Only™ (chest compression only) CPR is now endorsed by the AH...
• Stolz, U., Stolz, U., Spaite, D. W., Sanders, A. B., Panchal, A. R., Mullins, T., Kern, K. B., Geyer, B., Ewy, G. A., & Bobrow, B. (2010). Abstract 36: The Impact of a Statewide, Comprehensive System of Care on Survival From Out-of-Hospital Cardiac Arrest. Circulation, 122.
• Bobrow, B. J., Spaite, D. W., & Bobrow, B. J. (2009). Do not pardon the interruption.. Annals of emergency medicine, 54(5), 653-5. doi:10.1016/j.annemergmed.2009.06.508
• Bobrow, B. J., Vadeboncoeur, T. F., Striegel, T., Spaite, D. W., Sanders, A. B., Mullins, T., Kern, K. B., Geyer, B. C., Ewy, G. A., Clark, L., & Bobrow, B. J. (2009). Abstract P36: Statewide Network of Cardiac Arrest Centers Improves Survival From Out of Hospital Cardiac Arrest. Circulation, 120.
• Bobrow, B. J., Vadeboncouer, T., Spaite, D. W., Mullins, T., Lovecchio, F., Geyer, B., Ewy, G. A., Clark, L., Chikani, V., Bunis, J., & Bobrow, B. J. (2009). Abstract 11: The Impact of State and National Efforts to Improve Bystander CPR Rates in Arizona. Circulation, 120.
• Bobrow, B. J., Valenzuela, D., Stapczynski, S., Spaite, D. W., Smith, G. B., Gallagher, J. J., Ducote, J., Clark, L., Chikani, V., & Bobrow, B. J. (2009). Abstract P177: Fire Department-Led Community CPR Education Impacts Bystander CPR Performance. Circulation, 120.
• Bobrow, B. J., Wells, G. A., Vadeboncoeur, T. F., Stiell, I. G., Spaite, D. W., Maloney, J., Dreyer, J., Denninghoff, K. R., Boer, M. D., & Bobrow, B. J. (2009). Effect of transport interval on out-of-hospital cardiac arrest survival in the OPALS study: implications for triaging patients to specialized cardiac arrest centers.. Annals of emergency medicine, 54(2), 248-55. doi:10.1016/j.annemergmed.2008.11.020
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  To identify any association between out-of-hospital transport interval and survival to hospital discharge in victims of out-of-hospital cardiac arrest..Data from the Ontario Prehospital Advanced Life Support Study (January 1, 1991, to December 31, 2002), an Utstein-compliant registry of out-of-hospital cardiac arrest patients from 21 communities, were analyzed. Logistic regression identified factors that were independently associated with survival in consecutive adult, nontraumatic, out-of-hospital cardiac arrest patients and in the subgroup with return of spontaneous circulation..A total of 18,987 patients met criteria and 15,559 (81.9%) had complete data for analysis (study group). Return of spontaneous circulation was achieved in 2,299 patients (14.8%), and 689 (4.4%) survived to hospital discharge. Median transport interval was 4.0 minutes (25th quartile 3.0 minutes; 75th quartile 6.2 minutes) for survivors and 4.2 minutes (25th quartile 3.0, 75th quartile 6.2) for nonsurvivors. Logistic regression revealed multiple factors that were independently associated with survival: witnessed arrest (odds ratio 2.61; 95% confidence interval [CI] 2.05 to 3.34), bystander cardiopulmonary resuscitation (odds ratio 2.22; 95% CI 1.82 to 2.70), initial rhythm of ventricular fibrillation/tachycardia (odds ratio 2.22; 95% CI 1.97 to 2.50), and shorter emergency medical services (EMS) response interval (odds ratio 1.26; 95% CI 1.20 to 1.33). There was no association between transport interval and survival in either the study group (odds ratio 1.01; 95% CI 0.99 to 1.05) or the return of spontaneous circulation subgroup (odds ratio 1.04; 95% CI 0.99, 1.08)..In a large out-of-hospital cardiac arrest study from demographically diverse EMS systems, longer transport interval was not associated with decreased survival. Given the growing evidence showing major influence from specialized postarrest care, these findings support conducting clinical trials that assess the effectiveness and safety of bypassing local hospitals to take patients to regional cardiac arrest centers.
• Spaite, D. W. (2009). Lay responder defibrillation, pancake breakfasts, and survival from out-of-hospital cardiac arrest.. Annals of emergency medicine, 54(2), 236-8. doi:10.1016/j.annemergmed.2009.03.012
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Sanders, A. B., Kern, K. B., Ewy, G. A., Clark, L., Chikani, V., Bobrow, B. J., & Berg, R. A. (2008). Abstract P55: Survival From Out-of-Hospital Cardiac Arrest Among Patients Receiving AHA 2000 ACLS Guidelines, AHA 2005 ACLS Guidelines, or Cardiocerebral Resuscitation: A Statewide Analysis. Circulation, 118.
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  Objective: Survival of patients with out-of-hospital cardiac arrest (OHCA) receiving standard ACLS before and after the transition from AHA 2000 to 2005 guidelines in EMS systems across Arizona was...
• Vadeboncoeur, T. F., Spaite, D. W., Sanders, A. B., Mullins, T., Clark, L., Chikani, V., & Bobrow, B. J. (2008). The impact of prehospital transport interval on survival in out-of-hospital cardiac arrest: implications for regionalization of post-resuscitation care.. Resuscitation, 79(1), 61-6. doi:10.1016/j.resuscitation.2008.05.006
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  There is growing evidence that therapeutic hypothermia and other post-resuscitation care improves outcomes in out-of-hospital cardiac arrest (OHCA). Thus, transporting patients with return of spontaneous circulation (ROSC) to specialized facilities may increase survival rates. However, it is unknown whether prolonging transport to reach a designated facility would be detrimental..Data from OHCA patients treated in EMS systems that cover approximately 70% of Arizona's population were evaluated (October 2004-December 2006). We analyzed the association between transport interval (depart scene to ED arrival) and survival to hospital discharge in adult, non-traumatic OHCA patients and in the subgroup who achieved ROSC and remained comatose..1846 OHCA occurred prior to EMS arrival. Complete transport interval data were available for 1177 (63.8%) patients (study group). 253 patients (21.5%) achieved ROSC and remained comatose making them theoretically eligible for transport to specialized care. Overall, 70 patients (5.9%) survived and 43 (17.0%) comatose ROSC patients survived. Mean transport interval for the study group was 6.9 min (95% CI: 6.7, 7.1). Logistic regression revealed factors that were independently associated with survival: witnessed arrest, bystander CPR, method of CPR, initial rhythm of ventricular fibrillation, and shorter EMS response time interval. There was no significant association between transport interval and outcome in either the overall study group (OR=1.2; 0.77, 1.8) or in the comatose, ROSC subgroup (OR 0.94; 0.51, 1.8)..Survival was not significantly impacted by transport interval. This suggests that a modest increase in transport interval from bypassing the closest hospital en route to specialized care is safe and warrants further investigation.
• Wells, G. A., Stiell, I. G., Spaite, D. W., Pickett, W., Nesbitt, L. P., Munkley, D. P., Maloney, J., Lyver, M. B., Luinstra-toohey, L., Field, B. J., Dreyer, J., Campeau, T., & Banek, J. (2008). The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity.. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 178(9), 1141-52. doi:10.1503/cmaj.071154
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  To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established.The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge..Among the 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16)..The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.
• Spaite, D. W., Nichol, G., Maio, R. F., Lerner, E. B., & Garrison, H. G. (2007). A comprehensive framework for determining the cost of an emergency medical services system.. Annals of emergency medicine, 49(3), 304-13. doi:10.1016/j.annemergmed.2006.09.019
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  To determine the cost of an emergency medical services (EMS) system, researchers, policymakers, and EMS providers need a framework with which to identify the components of the system that must be included in any cost calculations. Such a framework will allow for cost comparisons across studies, communities, and interventions. The objective of this article is to present an EMS cost framework. This framework was developed by a consensus panel after analysis of existing peer-reviewed and non-peer-reviewed resources, as well as independent expert input. The components of the framework include administrative overhead, bystander response, communications, equipment, human resources, information systems, medical oversight, physical plant, training, and vehicles. There is no hierarchical rank to these components; they are all necessary. Within each component, there are subcomponents that must be considered. This framework can be used to standardize the calculation of EMS system costs to a community. Standardizing the calculation of EMS cost will allow for comparisons of costs between studies, communities, and interventions.
• Wells, G. A., Toohey, L. L., Stiell, I. G., Spaite, D. W., Nesbitt, L. P., Munkley, D., Maloney, J., Lyver, M. B., Field, B. J., Dreyer, J., Dagnone, E., & Campeau, T. (2007). Advanced life support for out-of-hospital respiratory distress.. The New England journal of medicine, 356(21), 2156-64. doi:10.1056/nejmoa060334
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  Respiratory distress is a common symptom of patients transported to hospitals by emergency medical services (EMS) personnel. The benefit of advanced life support for such patients has not been established..The Ontario Prehospital Advanced Life Support (OPALS) Study was a controlled clinical trial that was conducted in 15 cities before and after the implementation of a program to provide advanced life support for patients with out-of-hospital respiratory distress. Paramedics were trained in standard advanced life support, including endotracheal intubation and the administration of intravenous drugs..The clinical characteristics of the 8138 patients in the two phases of the study were similar. During the first phase, no patients were treated by paramedics trained in advanced life support; during the second phase, 56.6% of patients received this treatment. Endotracheal intubation was performed in 1.4% of the patients, and intravenous drugs were administered to 15.0% during the second phase. This phase of the study was also marked by a substantial increase in the use of nebulized salbutamol and sublingual nitroglycerin for the relief of symptoms. The rate of death among all patients decreased significantly, from 14.3% to 12.4% (absolute difference, 1.9%; 95% confidence interval [CI], 0.4 to 3.4; P=0.01) from the basic-life-support phase to the advanced-life-support phase (adjusted odds ratio, 1.3; 95% CI, 1.1 to 1.5)..The addition of a specific regimen of out-of-hospital advanced-life-support interventions to an existing EMS system that provides basic life support was associated with a decrease in the rate of death of 1.9 percentage points among patients with respiratory distress.
• Spaite, D. W. (2006). The future of emergency care in the United States: the Institute of Medicine Subcommittee on Prehospital Emergency Medical Services.. Annals of emergency medicine, 48(2), 126-30. doi:10.1016/j.annemergmed.2006.06.019
• Spaite, D. W., Nichol, G., Maio, R. F., Lerner, E. B., & Garrison, H. G. (2006). Economic value of out-of-hospital emergency care: a structured literature review.. Annals of emergency medicine, 47(6), 515-24. doi:10.1016/j.annemergmed.2006.01.012
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  The evaluation of the impact of out-of-hospital emergency care is a relatively new research focus. As such, there is a compelling need to determine how finite health care resources should be used in this setting. The objective of this study is to conduct a structured review of published economic evaluations of out-of-hospital emergency care to assess its economic value..A structured literature search and structured review of articles pertaining to the economic value of out-of-hospital care was performed. The bibliographic database MEDLINE was searched for pertinent English-language articles published between 1966 and 2003. The search used the medical subject headings "emergency medical services" and "emergency medical technician" and was limited to the subheading "economics" and crossed with the medical subject heading "economics." The titles generated by this search were systematically reviewed and limited by topic. Abstracts from the identified titles were reviewed to select a final set of pertinent articles. These articles were further limited based on explicit inclusion and exclusion criteria. Authors used a previously published structured evaluation tool to review the final set of identified articles for quality and content..The initial MEDLINE search identified 3,533 citations. From this set, 535 potentially relevant abstracts were reviewed. From the abstract review, 46 articles were identified, along with an additional 14 from searching the secondary references. Of these 60 articles, 32 met the review inclusion criteria and were subjected to a full structured review. These studies predominantly addressed the cost of cardiac arrest (n=13, 41%), major trauma (n=8, 25%), and emergency medical services treatment in general (n=8, 25%). Only 14 studies considered the costs and consequences of competing alternatives. Of these, 2 were cost-benefit and 12 were cost-effectiveness evaluations. Two of the 14 studies met all 10 criteria for high-quality economic evaluation, whereas 2 others met none..There is a paucity of out-of-hospital care literature that addresses cost and economic value. The extant literature is limited in scope, poor in quality, and evaluates small subsets of out-of-hospital emergency care costs. Favorable cost-effectiveness has not been firmly established for most aspects of out-of-hospital emergency care.
• Stiell, I. G., Spaite, D. W., O'malley, P. J., Miller, D. R., Maio, R. F., Mackenzie, E. J., Keim, S. M., Gregor, M. A., Garrison, H. G., Desmond, J. S., Chew, J. L., & Cayten, C. G. (2004). Establishing the scope and methodological approach to out-of-hospital outcomes and effectiveness research.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 11(10), 1067-73. doi:10.1197/j.aem.2004.04.014
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  Outcomes research offers out-of-hospital medicine a valuable methodology for studying the effectiveness of services provided in the out-of hospital setting. A clear understanding of the history and constructs of outcomes research is necessary for its integration into emergency medical services research. This report describes the conceptual framework of outcomes research and key methodological considerations for the successful implementation of out-of-hospital outcomes research. Illustrations of the specific applications of outcomes research and implications to existing methodologies are given, as well as suggestions for improved interdisciplinary research.
• Stiell, I. G., Spaite, D. W., O'malley, P. J., Miller, D. R., Maio, R. F., Mackenzie, E. J., Keim, S. M., Gregor, M. A., Garrison, H. G., Desmond, J. S., Chew, J. L., & Cayten, C. G. (2004). Risk adjustment and outcome measures for out-of-hospital respiratory distress.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 11(10), 1074-81. doi:10.1197/j.aem.2004.03.010
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  The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work, this group delineated the priority conditions, described conceptual models, suggested core and risk adjustment measures potentially useful to emergency medical services research, and summarized out-of-hospital pain measurement. In this fifth article in the EMSOP series, the authors recommend specific risk-adjustment measures and outcome measures for use in out-of-hospital research on patients presenting with respiratory distress. The methodology included systematic literature searches and a structured review by an expert panel. The EMSOP group recommends use of pulse oximetry, peak expiratory flow rate, and the visual analog dyspnea scale as potential risk-adjustment measures and outcome measures for out-of-hospital research in patients with respiratory distress. Furthermore, using mortality as an outcome measure is also recommended. Future research is needed to alleviate the paucity of validated tools for out-of-hospital outcomes research.
• Watts, B. A., Stiell, I. G., Spaite, D. W., Nesbitt, L. P., Kline, J. A., Jones, A. E., & Hasan, N. (2004). Nontraumatic out-of-hospital hypotension predicts inhospital mortality.. Annals of emergency medicine, 43(1), 106-13. doi:10.1016/j.annemergmed.2003.08.008
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  Out-of-hospital hypotension may signify need for intensive resuscitation and rapid diagnosis on emergency department (ED) arrival. We hypothesized that nontraumatic out-of-hospital hypotension confers risk of inhospital mortality..This was a multicenter study of ambulance-transported, nontrauma, non-cardiopulmonary resuscitation patients conducted at 2 venues: (1) a cross-sectional risk assessment study of high-priority medical transports at a US metropolitan county; and (2) a Canadian prospective multicenter cohort study of patients with respiratory distress. Data at both venues were extracted from prospectively recorded, standardized run sheets by either a physician or a paramedic. Data extraction and analysis at each venue were conducted independently. Exposures to hypotension were defined as age older than 17 years old, systolic blood pressure less than 100 mm Hg during transport, and 1 or more of 10 predefined symptoms of circulatory insufficiency. Nonexposures to hypotension had the same definition as exposures, except the systolic blood pressure had to be more than 100 mm Hg during the entire out-of-hospital transport. The main outcome variable was inhospital mortality..At venue 1, of 3,128 transports, 395 (13%) exposures and 395 nonexposures were identified. Inhospital mortality of exposures was 26% versus 8% for nonexposures (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] 2.0 to 5.9). At venue 2, of 7,679 transports, 532 exposures (7%) and 7,147 nonexposures were identified. Out-of-hospital exposure to hypotension conferred a mortality rate of 32% versus 11% for nonexposures (OR 3.0; 95% CI 2.4 to 3.7), representing a sensitivity of 18% and a specificity of 95%..The inhospital mortality rate after out-of-hospital, nontraumatic hypotension is high and reproducible. Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension.
• Wells, G. A., Stiell, I. G., Spaite, D. W., Nichol, G., Nesbitt, L. P., Munkley, D., Maio, V. J., Lyver, M. B., Luinstra-toohey, L., Field, B. J., Dagnone, E., Cousineau, D., Campeau, T., & Blackburn, J. (2004). Advanced cardiac life support in out-of-hospital cardiac arrest.. The New England journal of medicine, 351(7), 647-56. doi:10.1056/nejmoa040325
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  The Ontario Prehospital Advanced Life Support (OPALS) Study tested the incremental effect on the rate of survival after out-of-hospital cardiac arrest of adding a program of advanced life support to a program of rapid defibrillation..This multicenter, controlled clinical trial was conducted in 17 cities before and after advanced-life-support programs were instituted and enrolled 5638 patients who had had cardiac arrest outside the hospital. Of those patients, 1391 were enrolled during the rapid-defibrillation phase and 4247 during the subsequent advanced-life-support phase. Paramedics were trained in standard advanced life support, which includes endotracheal intubation and the administration of intravenous drugs..From the rapid-defibrillation phase to the advanced-life-support phase, the rate of admission to a hospital increased significantly (10.9 percent vs. 14.6 percent, P
• Spaite, D. W., & Criss, E. A. (2003). Out-of-hospital rapid sequence intubation: are we helping or hurting our patients?. Annals of emergency medicine, 42(6), 729-30. doi:10.1016/s0196-0644(03)00822-9
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  In this issue, Dunford et al1 present data related to rapid sequence intubation of patients with severe head injuries in the out-of-hospital setting. The application of recording oximeters throughout the process of rapid sequence intubation allowed the evaluation of oxygen saturation and pulse rate. An amazing 57% of these trauma victims demonstrated desaturation during outof-hospital rapid sequence intubation. Among those who experienced desaturation, 84% had initial oxygen saturations in the normal range with the utilization of basic airway skills alone. The median duration of desaturation was 2 minutes and 40 seconds, with 1 patient remaining hypoxemic for 4 minutes and 30 seconds. The median decrease in oxygen saturation was 22%. In addition, nearly 1 in 5 patients experienced marked bradycardia during desaturation. It is also notable that, in 84% of patients who experienced desaturation, the paramedics described the rapid sequence intubation as “easy.” This investigation is a substudy of the San Diego Paramedic RSI Trial. The outcomes from the overall study have recently been published by Davis et al.2 This report demonstrated that paramedic rapid sequence intubation in severely head-injured patients was associated with an increase in mortality and a decrease in “good” outcomes compared with matched historical controls. Out-of-hospital intubation has been the standard of care in many emergency medical services (EMS) systems for several decades. Unfortunately, the failure to perform controlled studies during the early years of implementation has meant that we do not know the effect of this intervention on patients. Recent reports of the Ontario Prehospital ALS Project (OPALS) have shown a dramatic improvement in survival for patients presenting to the EMS system with respiratory distress after the inception of advanced life support.3-6 Unfortunately, in the OPALS study, the effect of intubation could not be separated out from the other interventions implemented in the “advanced life support package.” However, it is probably reasonable to assume that outof-hospital intubation accounted for at least a portion of the improved survival rates. Despite the absence of proof that out-of-hospital intubation is safe and effective in the out-of-hospital setting, there has been little controversy in the literature about the appropriateness of its use. Scores of reports and vast experience in many systems have documented typical intubation success rates well in excess of 90%. However, much less is known about the safety and effectiveness of out-of-hospital rapid sequence intubation.7-17 One of the most remarkable aspects of the majority of the previous reports of out-of-hospital rapid sequence intubation is the near absence of the reporting of significant complications. The work of Dunford et al1 brings into question the validity of the low complication rates in those reports. The finding detailed in this edition is a profound one: in a busy, metropolitan EMS system with substantial medical oversight and experienced paramedics, a staggering rate of significant desaturation occurs during rapid sequence intubation. It appears that, as with other reports, these complications would have gone unreported if it were not for the technology available to passively, automatically, and reliably record desaturation. The implication of this work goes far beyond just rapid sequence intubation. The reality is, the EMS literature is replete with studies evaluating the implementation of new treatments and procedures that report extremely low complication rates. The vast majority of these studies have been retrospective and relied nearly entirely on EMS personnel identifying and documentE M E R G E N C Y M E D I C A L S E R V I C E S / E D I T O R I A L
• Walter, F. G., Valenzuela, T. D., Spaite, D. W., Criss, E. A., Bey, T., & Bates, G. (2003). Hazardous materials responses in a mid-sized metropolitan area.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 7(2), 214-8. doi:10.1080/10903120390936806
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  To determine the chemicals involved in fire department hazardous materials (hazmat) responses and analyze the concomitant emergency medical services' patient care needs..The setting was a mid-sized metropolitan area in the southwestern United States with a population base of 400,000 and an incorporated area of 165 square miles. The authors conducted a retrospective evaluation of all fire department hazmat reports, with associated emergency medical services patient encounter forms, and in-patient hospital records from January 1, 1992, through December 31, 1994..The fire department hazardous materials control team responded to 468 hazmat incidents, involving 62 chemicals. The majority of incidents occurred on city streets, with a mean incident duration of 46 minutes. More than 70% of the responses involved flammable gases or liquids. A total of 32 incidents generated 85 patients, 53% of whom required transport for further evaluation and care. Most patients were exposed to airborne toxicants. Only two patients required hospital admission for carbon monoxide poisoning..Most hazmat incidents result in few exposed patients who require emergency medical services care. Most patients were exposed to airborne toxicants and very few required hospitalization. Routine data analysis such as this provides emergency response personnel with the opportunity to evaluate current emergency plans and identify areas where additional training may be necessary.
• Wells, G. A., Stiell, I. G., Spaite, D. W., & Maio, V. J. (2003). Optimal defibrillation response intervals for maximum out-of-hospital cardiac arrest survival rates.. Annals of emergency medicine, 42(2), 242-50. doi:10.1067/mem.2003.266
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  Many centers optimize their emergency medical services (EMS) systems to achieve a target defibrillation response interval of "call received by dispatch" to "arrival at scene by responder with defibrillator" in 8 minutes or less for at least 90% of cardiac arrest cases. The objective of this study was to analyze survival as a function of time to test the evidence for this standard..This prospective cohort study included all adult, cardiac etiology, out-of-hospital cardiac arrest cases from phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) study. Patients in the 21 Ontario study communities received a basic life support level of care with defibrillation by ambulance and firefighters but no advanced life support. Survival was plotted as a function of the defibrillation response interval. The equation of the curve, generated by means of logistic regression, was used to estimate survival at various defibrillation response interval cutoff points..From January 1, 1991, to December 31, 1997, there were 392 (4.2%) survivors overall among the 9,273 patients treated. The defibrillation response interval mean was 6.2 minutes, and the 90th percentile was 9.3 minutes. There was a steep decrease in the first 5 minutes of the survival curve, beyond which the slope gradually leveled off. Controlling for known covariates, the decrement in the odds of survival with increasing response interval was 0.77 per minute (95% confidence interval 0.74 to 0.83). The survival function predicts, for successive 90th percentile cutoff points, both survival rates and additional lives saved per year in the OPALS communities compared with the 8-minute standard: 9 minutes (4.6%; -18 lives), 8 minutes (5.9%; 0 lives), 7 minutes (7.5%; 23 lives), 6 minutes (9.5%; 51 lives), and 5 minutes (12.0%; 86 lives)..The 8-minute target established in many communities is not supported by our data as the optimal EMS defibrillation response interval for cardiac arrest. EMS system leaders should consider the effect of decreasing the 90th percentile defibrillation response interval to less than 8 minutes.
• Wells, G. A., Stiell, I. G., Spaite, D. W., Nichol, G., Nesbitt, L., Maio, V. D., & Blackburn, J. (2003). Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation.. Circulation, 108(16), 1939-44. doi:10.1161/01.cir.0000095028.95929.b0
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  This study evaluated the prehospital factors associated with better health-related quality of life for survivors of out-of-hospital cardiac arrest..This prospective, 20-community, cohort study involved consecutive, adult out-of-hospital cardiac arrest patients who survived to 1 year. Patients were contacted by telephone and evaluated for the Health Utilities Index Mark III (HUI3), which describes health as a utility score on a scale from 0 (dead) to 1.0 (perfect health). The 8091 cardiac arrest patients had overall survival rates of 5.2% to hospital discharge and 4.0% to 1 year. We successfully contacted and evaluated 268 of 316 (84.8%) of known 1-year survivors. The median HUI3 score was 0.80 (interquartile range, 0.50 to 0.97), which compares well with age-adjusted values for the general population (0.83). Logistic regression identified 2 factors independently associated with very good quality of life (HUI3 >0.90) and their odds ratios (95% CIs), as follows: age 80 years or older, 0.3 (0.1 to 0.84), and citizen-initiated cardiopulmonary resuscitation (CPR), 2.0 (1.2 to 3.4) (Hosmer-Lemeshow goodness-of-fit statistic, 0.74)..This study is the largest ever conducted for out-of-hospital cardiac arrest survivors, clearly shows that these patients have good quality of life, and is the first to demonstrate that citizen-initiated CPR is strongly and independently associated with better quality of life. These results emphasize the importance of optimizing community citizen CPR readiness. Given the low rate of citizen-initiated CPR in many communities, we believe that local and national initiatives should vigorously promote the practice of bystander CPR.
• Foody, J. A., Stevens, C., Spaite, D. W., Graff, L., & Foody, J. M. (2002). Measuring and Improving Quality in Emergency Medicine. Academic Emergency Medicine, 9(11), 1091-1107. doi:10.1197/aemj.9.11.1091
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  The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as "the care health professionals would want to receive if they got sick." The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition-specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.
• Guisto, J., Valenzuela, T. D., Spaite, D. W., Lindberg, E., Lanyon, S., Hull, B., Guisto, J., Eyherabide, A., Criss, E. A., Conroy, C., & Bartholomeaux, F. (2002). Rapid process redesign in a university-based emergency department: decreasing waiting time intervals and improving patient satisfaction.. Annals of emergency medicine, 39(2), 168-77. doi:10.1067/mem.2002.121215
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  Academic emergency departments are traditionally associated with inefficiency and long waits. The academic medical model presents unique barriers to system changes. Several non-university-based EDs have undertaken process redesign, with significant decreases in patient waiting time intervals. This is the presentation of a rapid process redesign in a university-based ED to reduce waiting time intervals. We present the application of a process-improvement team approach to evaluate and redesign patient flow. As a result of this effort, the median waiting room time interval (triage to patient room) decreased from 31 minutes in January 1998 to 4 minutes in July 1998. ED throughput times also decreased, from 4 hours, 21 minutes in January 1998 to 2 hours, 55 minutes in July 1998. Urgent care waiting room time intervals decreased from 52 minutes to 7 minutes and throughput times from 2 hours, 9 minutes to 1 hour, 10 minutes. Patient satisfaction evaluations by an independent institute demonstrated dramatic improvement and establishment of a new benchmark for academic EDs. Process redesign is possible in a busy, complex, tertiary-care ED, with decreases in waiting time intervals and improvement in patient satisfaction. Major sustained support from top-level hospital administrators and physician leadership are fundamental prerequisites. With these in place, a process improvement team approach for evaluating and redesigning the patient care system can be successful.
• Spaite, D. W. (2002). In reply:. Annals of Emergency Medicine, 40(4), 438-442. doi:10.1067/mem.2002.128075
• Spaite, D. W. (2002). In reply:. Annals of Emergency Medicine, 40(6), 660. doi:10.1067/mem.2002.129715
• Spaite, D. W., Maio, R. F., & Garrison, H. G. (2002). Application of measurement tools to pediatric emergency medicine.. Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association, 2(4 Suppl), 319-22. doi:10.1367/1539-4409(2002)002<0319:aomttp>2.0.co;2
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  A focus on children and the limited time frame of the emergency care setting makes pediatric emergency medicine (EM) outcomes research a challenging endeavor. To address the challenges, pediatric EM researchers must choose their risk adjustment and outcomes measures carefully. This article provides guidance to those researchers through a series of questions and answers, with an emphasis on present and future measurement tools and the steps needed to further develop the field.
• Spaite, D. W., Mclean, S. A., Maio, R. F., & Garrison, H. G. (2002). Emergency medical services outcomes research: evaluating the effectiveness of prehospital care.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 6(2 Suppl), S52-6. doi:10.3109/10903120209102683
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  Outcomes research, a type of clinical research, focuses on determining whether interventions performed in clinical practice actually work. The techniques applied in clinical trials determine whether an intervention works in a controlled research setting (treatment efficacy). However, the goal of outcomes research is to determine whether an efficacious intervention can work in the less-controlled setting of ‘real-world’ practice (treatment effectiveness).
• Stevens, C., Spaite, D., Graff, L., & Foody, J. (2002). Measuring and improving quality in emergency medicine.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 9(11), 1091-107. doi:10.1111/j.1553-2712.2002.tb01563.x
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  The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as "the care health professionals would want to receive if they got sick." The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition-specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.
• Stiell, I. G., Spaite, D. W., O'malley, P. J., Miller, D. R., Maio, R. F., Mackenzie, E. J., Gregor, M. A., Garrison, H. G., Desmond, J. S., Chew, J. L., & Cayten, C. G. (2002). Emergency Medical Services Outcomes Project III (EMSOP III): the role of risk adjustment in out-of-hospital outcomes research.. Annals of emergency medicine, 40(1), 79-88. doi:10.1067/mem.2002.124758
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  The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. Fundamental to that purpose is the identification of priority conditions, risk-adjustment measures (RAMs), and outcome measures. In this third EMSOP article, we examine the topic of risk adjustment, discuss the relevance of risk adjustment for out-of-hospital outcomes research, and recommend RAMs that should be evaluated for potential use in emergency medical services (EMS) research. Risk adjustment allows better judgment about the effectiveness and quality of alternative therapies; it fosters a better comparison of potentially dissimilar groups of patients. By measuring RAMs, researchers account for an important source of variation in their studies. Core RAMs are those measures that might be necessary for out-of-hospital outcomes research involving any EMS condition. Potential core RAMs that should be evaluated for their feasibility, validity, and utility in out-of-hospital research include patient age and sex, race and ethnicity, vital signs, level of responsiveness, Glasgow Coma Scale, standardized time intervals, and EMS provider impression of the presenting condition. Potential core RAMs that could be obtained through linkage to other data sources and that should be evaluated for their feasibility, validity, and utility include principal diagnosis and patient comorbidity. We recommend that these potential core RAMs be systematically evaluated for use in risk adjustment of out-of-hospital patient groups that might be used for outcomes research
• Stiell, I. G., Spaite, D. W., O'malley, P. J., Miller, D. R., Malley, P. J., Maio, R. F., Mackenzie, E. J., Gregor, M. A., Garrison, H. G., Desmond, J. S., Chew, J. L., & Cayten, C. G. (2002). Emergency Medical Services Outcomes Project (EMSOP) IV: pain measurement in out-of-hospital outcomes research.. Annals of emergency medicine, 40(2), 172-9. doi:10.1067/mem.2002.124756
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  The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work (EMSOP I), discomfort had the highest weighted score among outcome categories for the top 3 adult conditions (ie, minor trauma, respiratory distress, chest pain) and the first and third highest rankings for children's conditions (ie, minor trauma, respiratory distress). In this fourth article in the EMSOP series, we discuss issues relevant to the measurement of pain in the out-of-hospital setting, recommended pain measures that require evaluation, and implications for outcomes research focusing on pain. For adults, adolescents, and older children, 2 verbal pain-rating scales are recommended for out-of-hospital evaluation: (1) the Adjective Response Scale, which includes the responses "none," "slight," "moderate," "severe," and "agonizing," and (2) the Numeric Response Scale, which includes responses from 0 (no pain) to 100 (worst pain imaginable). The Oucher Scale, combining a visual analog scale with pictures, seems most promising for out-of-hospital use among younger children. Future research in out-of-hospital care should be conducted to determine the utility and feasibility of these measures, as well as the effectiveness of interventions for pain relief.
• Wood, D., Williams, K., White, L. J., Werman, H., Walker, E., Susman, J., Spaite, D. W., Sinclair, J., Scott, J. M., Sayre, M. R., Ruple, J. A., Robinson, K., Pollak, A. N., Plant, J., Panjada, D. G., O'keefe, M., O'connor, R. E., Neely, K., Moore, L., , Mchenry, S. D., et al. (2002). National EMS Research Agenda.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 6(3 Suppl), S1-43.
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  Now, more than ever before, the spirit of the emergency services professional is recognized by people everywhere. Individuals from every walk of life comprehend the reality of the job these professionals do each day. Placing the safety of others above their own is their acknowledged responsibility. Rescue and treatment of ill and injured patients are their purpose as well as their gratification. The men and women who provide prehospital care are well aware of the unpredictable nature of emergency medical services (EMS). Prehospital care is given when and where it is needed: in urban settings with vertical challenges and gridlock; in rural settings with limited access; in confined spaces; within entrapments; or simply in the street, exposed to the elements. Despite the challenges, EMS professionals rise to the occasion to do their best with the resources available. Despite more than 30 years of dedicated service by thousands of EMS professionals, academic researchers, and public policy makers, the nation's EMS system is treating victims of illness and injury with little or no evidence that the care they provide is optimal. A national investment in the EMS research infrastructure is necessary to overcome obstacles currently impeding the accumulation of essential evidence of the effectiveness of EMS practice. Funding is required to train new researchers and to help them establish their careers. Financial backing is needed to support the development of effective prehospital treatments for the diseases that drive the design of the EMS system, including injury and sudden cardiac arrest. Innovative strategies to make EMS research easier to accomplish in emergency situations must be implemented. Researchers must have access to patient outcome information in order to evaluate and improve prehospital care. New biomedical and technical advances must be evaluated using scientific methodology. Research is the key to maintaining focus on improving the overall health of the community in a competitive and cost-conscious health care market. Most importantly, research is essential to ensure that the best possible patient care is provided in the prehospital setting. The bravery and dedication of EMS professionals cannot be underestimated. Images of firefighters, EMS personnel, and others going into danger while others are evacuating will remain burned in our collective consciousness. These professionals deserve the benefit of research to assist them in providing the best possible care in the challenging circumstances they encounter. With this document, we are seeking support for elevating the science of EMS and prehospital care to the next level. It is essential that we examine innovative ways to deliver prehospital care. Strategies to protect the safety of both the patient and the public safety worker must be devised and tested. There are many questions that remain to be asked, many practices to be evaluated, and many procedures to be improved. Research is the key to obtaining the answers.
• Zibulewsky, J., & Spaite, D. (2002). Academic department expansion: Yesterday's news [2] (multiple letters). Annals of Emergency Medicine, 40(4).
• Zibulewsky, J., & Spaite, D. W. (2002). Academic department expansion: Yesterday's news [2] (multiple letters). Annals of Emergency Medicine.
• Anderson, K., Valenzuela, T. D., Spaite, D. W., Siegel, E. M., Keim, S. M., & Anderson, K. A. (2001). Factors associated with CPR certification within an elderly community.. Resuscitation, 51(3), 269-74. doi:10.1016/s0300-9572(01)00418-x
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  To determine the frequency of CPR certification amongst residents living within a predominantly elderly community and examine the perceived barriers to learning basic CPR and factors associated with intent to become certified..A household survey was sent with a community newsletter to each home of a non-gated elderly community that requires one member of each household to be at least 55 years of age. The community consists of 2488 homes (approximately 4000 residents). Thirteen Yes/No questions were asked in a skip-pattern based upon the question: "Are you CPR certified?" Data analysis included univariate, bivariate, and logistic regression..947 participants with a mean age of 69 completed and returned the survey. Forty-eight percent of the participants had received prior training in CPR. Eighty-four percent were not currently certified in CPR, and top reasons cited were: 'don't know why' (36%), 'lack of interest' (20%), 'concerned about health risks' (17%). Forty-six percent of those not certified desired certification. Increasing age was inversely associated with CPR certification status and the desire to be certified..Almost half of the residents in this predominantly elderly community had received prior training in CPR, although most were not currently certified and cite significant specific and non-specific reasons and obstacles. Improved survival requires targeted interventions to achieve higher proportions of CPR-competent individuals in such high-risk communities.
• Spaite, D. W., Seng, M., Karriker, K. J., Conroy, C., & Battaglia, N. (2001). Improving emergency medical services for children with special health care needs: does training make a difference?. The American journal of emergency medicine, 19(6), 474-8. doi:10.1053/ajem.2001.27146
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  This study evaluated the impact of a paramedic training program on emergency medical services (EMS) responses for children with special health care needs. EMS responses for children with a congenital or acquired condition or a chronic physical or mental illness, were reviewed. Responses, related to the child's special health care need, involving paramedics who had completed our training program were compared with responses with paramedics not participating in the training. There was significantly more advanced life support treatment for responses with paramedics completing the training program compared with other responses. However, there was no significant difference in transport to a hospital or in-hospital admission between these 2 groups. This finding suggests that existing EMS protocols may play a more important role in emergency treatment and transport of children with special health care needs than specialized training of already certified paramedics.
• Spaite, D. W., Seng, M., Salik, R. M., Karriker, K. J., Conroy, C., & Battaglia, N. (2001). Emergency medical services assessment and treatment of children with special health care needs before and after specialized paramedic training.. Prehospital and disaster medicine, 16(2), 96-101. doi:10.1017/s1049023x00025760
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  This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management..Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program..Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items..Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.
• Stiell, I. G., Spaite, D. W., O'malley, P. J., Miller, D. R., Maio, R. F., Mackenzie, E. J., Gregor, M. A., Garrison, H. G., Desmond, J. S., Chew, J. L., & Cayten, C. G. (2001). Emergency Medical Services Outcomes Project (EMSOP) II: developing the foundation and conceptual models for out-of-hospital outcomes research.. Annals of emergency medicine, 37(6), 657-63. doi:10.1067/mem.2001.115215
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  Development of methodologically acceptable outcomes models for emergency medical services (EMS) is long overdue. In this article, the Emergency Medical Services Outcomes Project proposes a conceptual framework that will provide a foundation for future EMS outcomes research. The "Episode of Care Model" and the "Out-of-Hospital Unit of Service Model" are presented. The Episode of Care Model is useful in conditions in which interventions and outcomes, especially survival and major physiologic dysfunction, are linked in a time-dependent manner. Conditions such as severe trauma, anaphylaxis, airway obstruction, respiratory arrest, and nontraumatic cardiac arrest are amenable to this methodology. The Out-of-Hospital Unit of Service Model is essentially a subunit of the Episode of Care Model. It is valuable for evaluating conditions that have minimal-to-moderate therapeutic time dependency. This model should be used when studying outcomes limited to the out-of-hospital interval. An example of this is pain management for injuries sustained in motor vehicle crashes. These models can be applied to a wide spectrum of conditions and interventions. With the scrutiny of health care expenditures ever increasing, the identification of clinical interventions that objectively improve patient outcome takes on growing importance. Therefore, the development, dissemination, and use of meaningful methodologies for EMS outcomes research is key to the future of EMS system development and maintenance.
• Wells, G. A., Ward, R. E., Stiell, I. G., Spaite, D. W., Munkley, D. P., Maio, V. J., Lyver, M. B., & Field, B. J. (2001). CPR-only survivors of out-of-hospital cardiac arrest: implications for out-of-hospital care and cardiac arrest research methodology.. Annals of emergency medicine, 37(6), 602-8. doi:10.1067/mem.2001.114302
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  There is little evidence that cardiopulmonary resuscitation (CPR) alone may lead to the resuscitation of cardiac arrest victims with other than respiratory causes (eg, pediatric arrest, drowning, drug overdose). The objective of this study was to identify out-of-hospital cardiac arrest survivors resuscitated without defibrillation or advanced cardiac life support..This observational cohort included all adult survivors of out-of-hospital cardiac arrest of a cardiac cause from phases I and II of the Ontario Prehospital Advanced Life Support Study. During the study period, the system provided a basic life support/defibrillation level of care but no advanced life support. CPR-only patients were patients determined to be without vital signs by EMS personnel who regained a palpable pulse in the field with precordial thump or CPR only and then were admitted alive to the hospital. Six members of a 7-member expert review panel had to rate the patient as either probably or definitely having an out-of-hospital cardiac arrest, and a rhythm strip consistent with a cardiac arrest rhythm had to be present to be considered a patient. Criteria considered were witness status, citizen or first responder CPR, CPR duration, arrest rhythm and rate, and performance of precordial thump..From January 1, 1991, to June 30, 1997, 9,667 patients with out-of-hospital cardiac arrest were treated. The overall survival rate to hospital discharge was 4.6%. There were 97 apparent CPR-only patients admitted to the hospital. Application of the inclusion criteria yielded 24 CPR-only patients who had true out-of-hospital cardiac arrest and 73 patients judged not to have cardiac arrest. Of the 24 true CPR-only patients admitted to the hospital, 15 patients were discharged alive, 10 patients were witnessed by bystanders, and 7 patients were witnessed by EMS personnel. The initial arrest rhythm was pulseless electrical activity in 9 patients, asystole in 12 patients, and ventricular tachycardia in 3 patients. One patient with ventricular tachycardia converted to sinus tachycardia with a single precordial thump..CPR-only survivors of true out-of-hospital cardiac arrest do exist; some victims of out-of-hospital cardiac arrest of primary cardiac cause can survive after provision of out-of-hospital basic life support care only. However, many patients found to be pulseless by means of out-of-hospital evaluation likely did not have a true cardiac arrest. This has implications for the survival rates of most, if not all, previous cardiac arrest reports. Survival rates from cardiac arrest may actually be lower if one excludes survivors who never had a true arrest. The absence of vital signs by out-of-hospital assessment alone is not adequate to include patients in research reports or quality evaluations for cardiac arrest.
• Meislin, H. W., Valenzuela, T. D., Tibbitts, M., Spaite, D. W., Seng, M., Meislin, H. W., Karriker, K. J., Criss, E. A., Conroy, C., & Battaglia, N. (2000). Use of emergency medical services by children with special health care needs.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 4(1), 19-23. doi:10.1080/10903120090941579
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  This study describes emergency medical services (EMS) responses for children with special health care needs (CSHCN) in an urban area over a one-year period..A prospective surveillance system was established to identify EMS responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness. Responses related to the special health care needs of the child were compared with unrelated responses..During a one-year period, 924 responses were identified. Fewer than half of the responses were related to the child's special health care need. Younger children were significantly more likely to have a response related to their special needs than older children. Among related responses, seizure disorder was the most common diagnosis, while asthma was more common for unrelated responses. Almost 58% of the responses resulted in transport of the child to a hospital..Emergency medical services responses related to a child's special health care needs differ from unrelated responses. The most common special health care needs of children did not require treatment beyond the prehospital care provider's usual standard of care. These results are relevant for communities providing EMS services for CSHCN.
• Meislin, H. W., Valenzuela, T. D., Tibbitts, M., Spaite, D. W., Seng, M., Salik, R. M., Meislin, H. W., Karriker, K. J., Conroy, C., & Battaglia, N. (2000). Increasing paramedics' comfort and knowledge about children with special health care needs.. The American journal of emergency medicine, 18(7), 747-52. doi:10.1053/ajem.2000.16300
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  This study evaluated a continuing education program for paramedics about children with special health care needs (CSHCN). Pretraining, posttraining, and follow-up surveys containing two scales (comfort with CSHCN management skills and comfort with Pediatric Advanced Life Support [PALS] skills) were administered. Objective measures of knowledge were obtained from pre- and posttraining tests. Differences in average scores were assessed using t-tests. Response rates for paramedics completing the program ranged from 94% for the posttraining survey, 81% for the initial comfort survey, 56% for the knowledge pretest, and 56% for the follow-up survey. PALS comfort scores were significantly higher than CSHCN comfort scores both before and after training, both P < .01. Posttraining surveys showed an increase in CSHCN comfort, P < .01. The follow-up surveys showed a significant decline in CSHCN comfort, P = .05. Scores on the tests showed a similar pattern, with a significant increase in knowledge from pre- to posttraining (P = .02) and a significant decrease in knowledge from posttraining to follow-up (P < .01). Comfort was significantly higher for standard pediatric skills than for specialized management skills. Completion of the self-study program was associated with an increase in comfort and knowledge, but there was some decay over time.
• Spaite, D. W., Mcnally, J., Falbo, S. C., Dart, R. C., & Bogdan, G. M. (2000). Recurrent coagulopathy after antivenom treatment of crotalid snakebite.. Southern Medical Journal, 93(6), 562-566. doi:10.1097/00007611-200006000-00003
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  BACKGROUND We studied whether recurrence of coagulopathy, defined as the return of a coagulation abnormality after initial normalization, occurred after the use of antivenin (Crotalidae) polyvalent. METHODS A retrospective, blinded, descriptive analysis of 354 consecutive cases of North American crotalid snake envenomation was done. Inclusion criteria were documented clinical evidence of crotalid snakebite, presence of a coagulopathy (platelet count
• Tibbitts, M., Spaite, D. W., Seng, M., Salik, R. M., Karriker, K. J., Conroy, C., & Battaglia, N. (2000). Education and PracticeTraining paramedics: Emergency care for children with special health care needs☆☆☆. Prehospital Emergency Care, 4(2).
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  Objective. To enhance knowledge and comfort related to the emergency care of children with special health care needs (CSHCN) through an innovative continuing education program for paramedics. Methods. A self-study program presenting in-depth information about common problems that affect the assessment and management of a child's airway, breathing, circulation, disability, and environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a video, practice mannequins, and skills evaluations to teach skills to paramedics employed at a municipal fire department. Results. Pre- and posttraining surveys found that the paramedics were significantly more comfortable with the assessment and management of CSHCN after the completion of the self-study program, with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale, t(37) = 12.87, p < 0.001. A skills evaluation showed that skills performance varied widely across 21 skills, ranging from skills mastery to low skills knowledge. On the posttraining survey, between 74% and 94% of the paramedics rated each topic (tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and latex allergy) as applicable to their practices as paramedics. Conclusion. Given the growing population of CSHCN, it is important to provide specialized education to increase an EMS provider's preparedness to respond to emergency situations involving children with special health care needs. PREHOSPITAL EMERGENCY CARE 2000;4:178-185
• Tibbitts, M., Spaite, D. W., Seng, M., Salik, R. M., Karriker, K. J., Conroy, C., & Battaglia, N. (2000). Training paramedics: emergency care for children with special health care needs.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 4(2), 178-85. doi:10.1080/10903120090941470
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  To enhance knowledge and comfort related to the emergency care of children with special health care needs (CSHCN) through an innovative continuing education program for paramedics..A self-study program presenting in-depth information about common problems that affect the assessment and management of a child's airway, breathing, circulation, disability, and environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a video, practice mannequins, and skills evaluations to teach skills to paramedics employed at a municipal fire department..Pre- and posttraining surveys found that the paramedics were significantly more comfortable with the assessment and management of CSHCN after the completion of the self-study program, with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale, t(37) = 12.87, p < 0.001. A skills evaluation showed that skills performance varied widely across 21 skills, ranging from skills mastery to low skills knowledge. On the posttraining survey, between 74% and 94% of the paramedics rated each topic (tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and latex allergy) as applicable to their practices as paramedics..Given the growing population of CSHCN, it is important to provide specialized education to increase an EMS provider's preparedness to respond to emergency situations involving children with special health care needs.
• Valenzuela, T. D., Spaite, D. W., Roe, D. J., Nichol, G., Hardman, R. G., & Clark, L. L. (2000). Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.. The New England journal of medicine, 343(17), 1206-9. doi:10.1056/nejm200010263431701
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  The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest..We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital..Automated external defibrillators were used, 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients 153 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (+/-SD) of 3.5+/-2.9 minutes from collapse to attachment of the defibrillator, 4.4+/-2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8+/-4.3 minutes from collapse to The arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes..Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates.
• Wells, G. A., Stiell, I. G., Spaite, D. W., & Maio, V. J. (2000). Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival. OPALS study group.. Annals of emergency medicine, 35(2), 138-46.
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  The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group..This prospective cohort included all adults with an EMS-witnessed cardiac arrest in the 21 communities of the Ontario Prehospital Advanced Life Support (OPALS) study. Systems provided a basic life support with defibrillation (BLS-D) level of care. Case and survival definitions followed the Utstein style. Descriptive and univariate methods (chi(2) and t test) were used to characterize EMS-witnessed cardiac arrest. Multivariate logistic regression was undertaken to assess predictors of survival to hospital discharge..From January 1, 1991, to December 31, 1996, there were 9,072 cardiac arrest cases in the study communities. Of these, 610 (6.7%) were EMS-witnessed. The majority had preexisting cardiac or respiratory disease (81.5%) and experienced prodromal symptoms before EMS personnel arrived (91.4%). An initial rhythm of pulseless electrical activity was present in 50.1% of the patients, ventricular fibrillation/ventricular tachycardia in 34.2%, and asystole in 15.7%. Survival to discharge was 12.6%. Multivariate analysis identified the following as independent predictors of survival (odds ratio with 95% confidence intervals [CIs]): nitroglycerin use before EMS arrival: 2.3 (95% CI 1.2 to 4.5), prodromal symptoms of chest pain: 2.5 (95% CI 1.4 to 4.5) or dyspnea: 0.5 (95% CI 0.3 to 1.0), and unconsciousness on EMS arrival: 0.5 (95% CI 0.2 to 0.9). Patients with chest pain were more likely than dyspneic patients to experience ventricular fibrillation/ventricular tachycardia (62% versus 17%, P
• Wells, G. A., Stiell, I. G., Spaite, D. W., & Maio, V. J. (2000). Cardiac arrest witnessed by emergency medical services personnel: descriptive epidemiology, prodromal symptoms, and predictors of survival.. Annals of emergency medicine, 35(2), 138-146. doi:10.1016/s0196-0644(00)70133-8
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  The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group..This prospective cohort included all adults with an EMS-witnessed cardiac arrest in the 21 communities of the Ontario Prehospital Advanced Life Support (OPALS) study. Systems provided a basic life support with defibrillation (BLS-D) level of care. Case and survival definitions followed the Utstein style. Descriptive and univariate methods (χ2 and t test) were used to characterize EMS-witnessed cardiac arrest. Multivariate logistic regression was undertaken to assess predictors of survival to hospital discharge..From January 1, 1991, to December 31, 1996, there were 9,072 cardiac arrest cases in the study communities. Of these, 610 (6.7%) were EMS-witnessed. The majority had preexisting cardiac or respiratory disease (81.5%) and experienced prodromal symptoms before EMS personnel arrived (91.4%). An initial rhythm of pulseless electrical activity was present in 50.1% of the patients, ventricular fibrillation/ventricular tachycardia in 34.2%, and asystole in 15.7%. Survival to discharge was 12.6%. Multivariate analysis identified the following as independent predictors of survival (odds ratio with 95% confidence intervals [CIs]): nitroglycerin use before EMS arrival: 2.3 (95% CI 1.2 to 4.5), prodromal symptoms of chest pain: 2.5 (95% CI 1.4 to 4.5) or dyspnea: 0.5 (95% CI 0.3 to 1.0), and unconsciousness on EMS arrival: 0.5 (95% CI 0.2 to 0.9). Patients with chest pain were more likely than dyspneic patients to experience ventricular fibrillation/ventricular tachycardia (62% versus 17%, P
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Detwiler, M., & Conroy, C. (1999). Development of an electronic emergency medical services patient care record.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 3(1), 54-9. doi:10.1080/10903129908958907
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  The need for valid and reliable emergency medical services (EMS) data has long been recognized. EMS data are useful for monitoring resources and operations, documenting patient care and outcome, and evaluating injury prevention strategies. The goal of this project was to develop a computerized data set with the capability to generate a patient care record (PCR) to overcome some of the current EMS data limitations..The authors discuss developing an electronic PCR and analysis data set containing 233 variables. Data are collected for the following: incident, response, scene, patient, history, primary survey (including vital signs), physical examination, physiologic scores, diagnostics, plan (medications and procedures), assessment, and reevaluation. Software on a portable computer installed in an EMS response unit utilizes a graphical user interface for data collection by prehospital emergency care providers. A data set stores codes corresponding to user's selections. This data set supports data storage and analysis. The electronic PCR and data set can be useful to EMS agencies for collecting, storing, reporting, and analyzing information..Variables are categorized into 12 main categories to categorize the variables and to drive data collection. The system provides the user with the ability to print out a record (using a portable printer installed in an ambulance) and analyze data stored in the data set..This computerized approach overcomes many limitations inherent with using paper-based systems for research. Linked with emergency department, hospital discharge, and mortality data, EMS data can be used in systems analyses related to patient outcome.
• Stiell, I. G., Spaite, D. W., O'malley, P. J., Miller, D. R., Maio, R. F., Mackenzie, E. J., Joyce, S. M., Hill, E. M., Gregor, M. A., Garrison, H. G., Desmond, J. S., Chewjr, J., Chew, J. L., & Cayten, C. G. (1999). Emergency medical services outcomes project I (EMSOP I): prioritizing conditions for outcomes research.. Annals of emergency medicine, 33(4), 423-32. doi:10.1016/s0196-0644(99)70307-0
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  Over the past several years, out-of-hospital EMS have come under increased scrutiny regarding the value of the range of EMS as currently provided. We used frequency data and expert opinion to rank-order EMS conditions for children and adults based on their potential value for the study of effectiveness of EMS care. Relief of discomfort was the outcome parameter EMS professionals identified as having the most potential impact for the majority of children and adults in the top quartile conditions. Future work from this project will identify appropriate severity and outcome measures that can be used to study these priority conditions. The results from the first year of this project will assist those interested in EMS outcomes research to focus their efforts. Furthermore, the results suggest that nonmortality out-come measures, such as relief of discomfort, may be important parameters in determining EMS effectiveness.
• Wells, G. A., Stiell, I. G., & Spaite, D. W. (1999). Improving Survival Following Out-of-Hospital Cardiac Arrest—Reply. JAMA, 282(11), 1033-1034.
• Wells, G. A., Ward, R., Stiell, I. G., Spaite, D. W., Munkley, D. P., Lyver, M. B., Luinstra, L. G., Field, B. J., & Demaio, V. J. (1999). Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ontario Prehospital Advanced Life Support.. Annals of emergency medicine, 33(1), 44-50. doi:10.1016/s0196-0644(99)70415-4
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  This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care..This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses..From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8% of cardiac arrests were witnessed by citizens, 14.5% received bystander CPR, 25.6% received CPR by fire or police, and 38.2% had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5% overall and 8.8% for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95% confidence intervals): age.81 (. 73,.89), bystander-witnessed arrest 4.05 (2.78, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped.76 (.71,.82)..This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and clearly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.
• Wells, G. A., Ward, R., Stiell, I. G., Spaite, D. W., Munkley, D. P., Maloney, J., Maio, V. J., Lyver, M. B., Luinstra, L. G., Iii, B. J., Field, B. J., Dagnone, E., & Campeau, T. (1999). Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support.. JAMA, 281(13), 1175-81. doi:10.1001/jama.281.13.1175
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  Survival rates for out-of-hospital cardiac arrest are low; published survival rates in Ontario are only 2.5%. This study represents phase II of the Ontario Prehospital Advanced Life Support (OPALS) study, which is designed to systematically evaluate the effectiveness and efficiency of various prehospital interventions for patients with cardiac arrest, trauma, and critical illnesses..To assess the impact on out-of-hospital cardiac arrest survival of the implementation of a rapid defibrillation program in a large multicenter emergency medical services (EMS) system with existing basic life support and defibrillation (BLS-D) level of care..Controlled clinical trial comparing survival for 36 months before (phase I) and 12 months after (phase II) system optimization..Nineteen urban and suburban Ontario communities (populations ranging from 16 000 to 750 000 [total, 2.7 million])..All patients who had out-of-hospital cardiac arrest in the study communities for whom resuscitation was attempted by emergency responders..Study communities optimized their EMS systems to achieve the target response interval from when a call was received until a vehicle stopped with a defibrillator of 8 minutes or less for 90% of cardiac arrest cases. Working both locally and provincially, communities implemented multiple measures, including defibrillation by firefighters, base paging, tiered response agreements with fire departments, continuous quality improvement for response intervals, and province-wide revision and implementation of standard dispatch policies. All response times were obtained from a central dispatch system..Survival to hospital discharge..The 4690 cardiac arrest patients studied in phase I and the 1641 in phase II were similar for all clinical and demographic characteristics, including age, sex, witnessed status, rhythm, and receipt of bystander cardiopulmonary resuscitation. The proportion of cases meeting the 8-minute response criterion improved (76.7% vs 92.5%; P
• Wells, G. A., Ward, R., Stiell, I. G., Spaite, D. W., O'brien, B., Nichol, G., Munkley, D. P., Lyver, M. B., Luinstra, L. G., Field, B. J., Dagnone, E., Campeau, T., & Anderson, S. (1999). The Ontario Prehospital Advanced Life Support (OPALS) study Part II: Rationale and methodology for trauma and respiratory distress patients. OPALS Study Group.. Annals of emergency medicine, 34(2), 256-62. doi:10.1016/s0196-0644(99)70241-6
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  The Ontario Prehospital Advanced Life Support (OPALS) Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period (1994-2002). The current article, Part II, describes in detail the rationale and methodology for major trauma and respiratory distress patients and for an economic evaluation of Advanced Life Support (ALS) programs in the OPALS Study. The OPALS Study, using a rigorous controlled methodology and a large sample size, should clearly indicate the benefit in trauma and respiratory distress patient survival and morbidity that results from the widespread introduction of prehospital ALS programs to communities of many different sizes. [Stiell IG, Wells GA, Spaite DW, Nichol G, O'Brien B, Munkley DP, Field BJ, Lyver MB, Luinstra LG, Dagnone E, Campeau T, Ward R, Anderson S, for the OPALS Study Group: The Ontario Prehospital Advanced Life Support (OPALS) Study Part II: Rationale and methodology for trauma and respiratory distress patients.
• Yealy, D. M., White, R. D., Wells, G. A., Stiell, I. G., Spaite, D. W., & Asplin, B. R. (1999). IMPROVING SURVIVAL FOLLOWING OUT-OF-HOSPITAL CARDIAC ARREST. AUTHORS' REPLY. JAMA, 282(11), 1033-1034.
• Zaritsky, A., Tittle, S., Spaite, D. W., Seidel, J. S., Maederis, D., Lewis, R. J., Jaffe, D. M., Henderson, D. P., Gausche, M., Espisito, T., Dean, J. M., & Cooper, A. (1999). Priorities for research in emergency medical services for children: results of a consensus conference.. Annals of emergency medicine, 33(2), 206-10. doi:10.1016/s0196-0644(99)70395-1
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  To arrive at a consensus on the priorities for future research in emergency medical services for children..A consensus group was convened using the Rand-UCLA Consensus Process. The group took part in a 3-phase process. Round 1 involved reviewing a compendium of relevant research articles and answering a mailed questionnaire. Panel members were asked to prioritize topics on the basis of the 1993 Institute of Medicine Report on Emergency Medical Services for Children. Participants were asked to rate each topic based on the significance of the research, and whether the topic would (1) improve general knowledge, (2) change behavior, (3) improve health, (4) decrease the cost of care, or (5) change public policy. A 4-point Likert scale was used. Participants were also asked if the research would require a multicenter study and if the research were feasible. Round 2 of the study involved a meeting of the panel, where the results of Round 1 were discussed and the topics were reprioritized. The topics were given a rank order and a final ranking was done in Round 3..The panel considered a list of 32 topics; these were combined and reworded to give them more precise meaning. Several new topics were also added. Fifteen topics were given a rank order and placed within the 7 broad categories of the Institute of Medicine report. Clinical aspects of emergency care, systems organization, configuration, and operation and injury prevention were given high priority rankings. The first 5 topics were very close in point-rank order..The panel was able to develop a list of important topics for future research in emergency medical services for children that can be used by foundations, governmental agencies, and others in setting a research agenda for such services.
• Zaritsky, A., Tittle, S., Spaite, D. W., Seidel, J. S., Maederis, D., Lewis, R. J., Jaffe, D., Henderson, D. P., Gausche, M., Espisito, T., Dean, J. M., & Cooper, A. (1999). Priorities for research in Emergency Medical Services for Children: results of a consensus conference. EMSC Research Agenda Consensus Committee, National EMSC Resource Alliance.. Journal of emergency nursing, 25(1), 12-6. doi:10.1016/s0099-1767(99)70122-4
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  The study objective was to arrive at a consensus on the priorities for future research in Emergency Medical Services for Children (EMSC)..A consensus group was convened using the Rand'-UCLA Consensus Process. The group took part in a 3-phase process. Phase I involved reviewing a compendium of relevant research articles and answering a mailed questionnaire. Panel members were asked to prioritize topics based on the 1993 Institute of Medicine Report on Emergency Medical Services for Children. Participants were asked to rate each topic based on the significance of the research and whether the topic would (1) improve general knowledge, (2) change behavior, (3) improve health, (4) decrease the cost of care, or (5) change public policy. A 4-point Likert scale was used. They were also asked in the research would require a multicenter study and if the research were feasible. Round II of the study involved a meeting of the panel, where the results of Round I were discussed and the topics reprioritized. The topics were given a rank order and a final ranking was done in Round III..The panel considered a list of 32 topics and these were combined and reworded to give them more precise meaning. Several new topics were also added. Fifteen topics were given a rank order and placed within the 7 broad categories of the Institute of Medicine report. Clinical aspects of emergency care systems organization, configuration and operation and injury prevention were given high priority rankings. The first 5 topics were very close in point-rank order..The panel was able to develop a list of important topics for future research in EMSC that can be used by foundations, governmental agencies, and others in setting a research agenda for EMSC.
• Zaritsky, A., Tittle, S., Spaite, D. W., Seidel, J. S., Maederis, D., Lewis, R. J., Jaffe, D., Henderson, D. P., Gausche, M., Espisito, T., Dean, J. M., & Cooper, A. (1999). Priorities for research in emergency medical services for children: results of a consensus conference.. Pediatric emergency care, 15(1), 55-8. doi:10.1097/00006565-199902000-00016
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  To arrive at a consensus on the priorities for future research in emergency medical services for children..A consensus group was convened using the Rand-UCLA Consensus Process. The group took part in a 3-phase process. Round I involved reviewing a compendium of relevant research articles and answering a mailed questionnaire. Panel members were asked to prioritize topics on the basis of the 1993 Institute of Medicine Report on Emergency Medical Services for Children. Participants were asked to rate each topic based on the significance of the research, and whether the topic would (1) improve general knowledge (2), change behavior (3), improve health (4), decrease the cost of care, or (5) change public policy. A 4-point Likert scale was used. Participants were also asked if the research would require a multicenter study and if the research were feasible. Round II of the study involved a meeting of the panel, where the results of Round I were discussed and the topics were reprioritized. The topics were given a rank order and a final ranking was done in Round III..The panel considered a list of 32 topics; these were combined and reworded to give them more precise meaning. Several new topics were also added. Fifteen topics were given a rank order and placed within the 7 broad categories of the Institute of Medicine report. Clinical aspects of emergency care, systems organization, configuration, and operation and injury prevention were given high priority rankings. The first 5 topics were very close in point-rank order..The panel was able to develop a list of important topics for future research in emergency medical services for children that can be used by foundations, governmental agencies, and others in setting research agenda for such services.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., & Criss, E. A. (1998). Prehospital advanced life support for major trauma: critical need for clinical trials.. Annals of emergency medicine, 32(4), 480-9. doi:10.1016/s0196-0644(98)70178-7
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  A widely diverse body of information exists on the use of Advanced Life Support procedures by prehospital personnel. We compared and contrasted the literature that currently exists on this topic. We examined methodologies, results, and conclusions for each article. We also stress the need for critical clinical evaluations in this arena.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Parks, B. O., Meislin, H. W., Judkins, D., Criss, E. A., Conroy, C., & Berger, R. (1998). Fatal Trauma: The Modal Distribution of Time to Death As a Function of Patient Demographics and Regional Resurces. Journal of Trauma Nursing, 5(1), 17-18. doi:10.1097/00043860-199801000-00005
• Spaite, D. W. (1998). Intubation by basic EMTs: lifesaving advance or catastrophic complication?. Annals of emergency medicine, 31(2), 276-7. doi:10.1016/s0196-0644(98)70319-1
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  Abstract See related article, p 228. [Spaite D: Intubation by basic EMTs: Lifesaving advance or catastrophic complication? Ann Emerg Med February 1998;31: 276-277.]
• Wells, G. A., Ward, R., Stiell, I. G., Spaite, D. W., Munkley, D. P., Maloney, J. P., Lyver, M. B., Luinstra, L. G., Jones, G. R., Jermyn, B. D., Field, B. J., Demaio, V. J., & Dagnone, E. (1998). The Ontario Prehospital Advanced Life Support (OPALS) Study: rationale and methodology for cardiac arrest patients.. Annals of emergency medicine, 32(2), 180-90. doi:10.1016/s0196-0644(98)70135-0
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  The Ontario Prehospital Advanced Life Support Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period. The study will evaluate the incremental benefit of rapid defibrillation and prehospital Advanced Cardiac Life Support measures for cardiac arrest survival and the benefit of Advanced Life Support for patients with traumatic injuries and other critically ill prehospital patients. This article describes the OPALS study with regard to the rationale and methodology for cardiac arrest patients.
• Wilson, E. M., Suter, R. E., Stewart, R. D., Spaite, D. W., Ryan, S. D., O'malley, P. J., Miller, D. R., Manz, D., Krakeel, J. J., Delbridge, T. R., Conn, A. K., Chew, J. L., & Bailey, B. (1998). EMS Agenda for the Future: where we are...where we want to be.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 2(1), 1-12. doi:10.1080/10903129808958832
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  During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the EMS Agenda for the Future. Fourteen EMS attributes were identified as requiring continued development in order to realize the vision established within the Agenda. They are integration of health services, EMS research, legislation and regulation, system finance, human resources, medical direction, education systems, public education, prevention, public access, communication systems, clinical care, information systems, and evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.
• Wilson, E. M., Suter, R. E., Stewart, R. D., Spaite, D. W., Ryan, S. D., O'malley, P. J., Miller, D. R., Manz, D., Krakeel, J. J., Delbridge, T. R., Conn, A. K., Chew, J. L., & Bailey, B. (1998). EMS agenda for the future: where we are ... where we want to be. EMS Agenda for the Future Steering Committee.. Annals of emergency medicine, 31(2), 251-63.
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  During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the "EMS Agenda for the Future." Fourteen EMS attributes were identified as requiring continued development in order to realize the vision established within the Agenda. They are Integration of Health Services, EMS Research, Legislation and Regulation, System Finance, Human Resources, Medical Direction, Education Systems, Public Education, Prevention, Public Access, Communication Systems, Clinical Care, Information Systems, and Evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care.
• Wilson, E. M., Suter, R. E., Stewart, R. D., Spaite, D. W., Ryan, S. D., O'malley, P. J., Miller§§--, D. R., Miller, D. R., Manz--, D., Krakeel, J. J., Delbridge, T. R., Conn, A. K., Chew, J. L., & Bailey-, B. (1998). EMS Agenda for the Future: Where We Are … Where We Want to Be. Annals of Emergency Medicine, 31(2), 251-263. doi:10.1016/s0196-0644(98)70316-6
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  Abstract During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the "EMS Agenda for the Future." Fourteen EMS attributes were identified as requiring continued development in order to realize the vision established within the Agenda. They are Integration of Health Services, EMS Research, Legislation and Regulation, System Finance, Human Resources, Medical Direction, Education Systems, Public Education, Prevention, Public Access, Communication Systems, Clinical Care, Information Systems, and Evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care. [Delbridge TR, Bailey B, Chew JL Jr, Conn AKT, Krakeel JJ, Manz D, Miller DR, O'Malley PJ, Ryan SD, Spaite DW, Stewart RD, Suter RE, Wilson EM: EMS agenda for the future: Where we are … where we want to be. Ann Emerg Med February 1998;31:251-263.]
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., & Criss, E. A. (1997). Developing a foundation for the evaluation of expanded-scope EMS: a window of opportunity that cannot be ignored.. Annals of emergency medicine, 30(6), 791-6. doi:10.1016/s0196-0644(97)70050-7
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  EMS systems are about to undergo a major transformation. Not only will the scope of EMS change, but many experts believe that it will dramatically expand. Some see the "expanded scope" as entailing relatively limited changes, whereas others consider them to be more broad. Although no agreement is evident about the definition for expanded-scope EMS, it is hoped that all EMS professionals can agree that it must be implemented in a manner that can be carefully evaluated to determine its effects on patients and EMS systems. We present a framework for evaluating the effect of expanded-scope EMS in the various types of systems that currently exist. Special consideration must be given to the indirect effects that system changes may have on survival from out-of-hospital cardiac arrest. Numerous issues will affect our ability to properly assess expanded-scope EMS. The basic research models necessary to assess the impact of system change are lacking. Few EMS systems consistently produce significant volumes of good systems research ... that is, there are few "EMS laboratories." Cost-effectiveness and issues surrounding the "societal value" of EMS remain essentially unstudied. Reliable scoring methods, severity scales, and outcome measures are lacking: and, it is ethically and logistically difficult to justify withholding the "standard of care" in an effort to understand the impact of EMS interventions. Despite all of these barriers, it is time to pay the price of doing methodologically sound evaluations that ensure the most optimal societal impact by the EMS systems of the future.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Farris, C., & Criss, E. A. (1997). Observational evaluation of compliance with traffic regulations among helmeted and nonhelmeted bicyclists.. Annals of emergency medicine, 29(5), 625-9. doi:10.1016/s0196-0644(97)70251-8
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  To evaluate whether helmeted bicyclists are more compliant with traffic regulations than nonhelmeted bicyclists..This prospective observational study, using a convenience sample, was conducted during daylight hours at three separate intersections, marked with legal stop signs, near the campus of a major university. Data collected included helmet use, legal hand signal use to indicate a turn or stop, and whether the bicyclist came to a complete stop before proceeding through the intersection..A total of 1,793 bicyclists were evaluated. Only 8.8% of the bicycle riders were wearing helmets. Helmeted bicyclists were 2.6 times more likely than nonhelmeted bicyclists to make legal stops (P < .000001; odds ratio [OR], 3.1; 95% confidence interval [CI], 2.1 to 4.6). They were also 7.1 times more likely to use hand signals (P < .000001; OR, 7.2; 95% CI, 2.8 to 18.2)..Helmeted bicycle riders showed a significantly greater compliance with two traffic laws than nonhelmeted bicyclists. They were 2.6 times more likely to stop at stop signs and 7.1 times more likely to use legal hand signals. This very strong association of helmet use with safer riding habits has implications for injury-control efforts aimed at preventing bicycle-related injuries.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Parks, B. O., Meislin, H. W., Judkins, D., Criss, E. A., Conroy, C., & Berger, R. (1997). Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources.. The Journal of trauma, 43(3), 433-40. doi:10.1097/00005373-199709000-00008
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  Unlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States..All deaths from blunt and penetrating trauma between November 15, 1991, and November 14, 1993, were included. As many as 150 variables were collected on each patient, including time of injury and time of death. Initial identification of cases was through manual review of death records. Information was supplemented by review of hospital records, case reports, and prehospital encounter forms..A total of 710 traumatic deaths were analyzed. Approximately half of the victims, 52%, were pronounced dead at the scene. Of the 48% who were hospitalized, the most frequent mechanism of injury was a fall. Neurologic dysfunction was the most common cause of death. Two distinct peaks of time were found on analysis: 23% of patients died within the first 60 minutes, and 35% of patients died at 24 to 48 hours after injury..Although there appears to continue to be a trimodal distribution of trauma deaths in urban environments, we found the distribution to be bimodal in an environment with a higher ratio of blunt to penetrating trauma.
• Valenzuela, T. D., Spaite, D. W., Roe, D. J., Larsen, M. P., & Cretin, S. (1997). Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model.. Circulation, 96(10), 3308-13. doi:10.1161/01.cir.96.10.3308
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  The study objective was to develop a simple, generalizable predictive model for survival after out-of-hospital cardiac arrest due to ventricular fibrillation..Logistic regression analysis of two retrospective series (n=205 and n=1667, respectively) of out-of-hospital cardiac arrests was performed on data sets from a Southwestern city (population, 415,000; area, 406 km2) and a Northwestern county (population, 1,038,000; area, 1399 km2). Both are served by similar two-tiered emergency response systems. All arrests were witnessed and occurred before the arrival of emergency responders, and the initial cardiac rhythm observed was ventricular fibrillation. The main outcome measure was survival to hospital discharge. Patient age, initiation of CPR by bystanders, interval from collapse to CPR, interval from collapse to defibrillation, bystander CPR/collapse-to-CPR interval interaction, and collapse-to-CPR/collapse-to-defibrillation interval interaction were significantly associated with survival. There was not a significant difference between observed survival rates at the two sites after control for significant predictors. A simplified predictive model retaining only collapse to CPR and collapse to defibrillation intervals performed comparably to the more complicated explanatory model..The effectiveness of prehospital interventions for out-of-hospital cardiac arrest may be estimated from their influence on collapse to CPR and collapse to defibrillation intervals. A model derived from combined data from two geographically distinct populations did not identify site as a predictor of survival if clinically relevant predictor variables were controlled for. This model can be generalized to other US populations and used to project the local effectiveness of interventions to improve cardiac arrest survival.
• Guisto, J. A., Meislin, H. W., Spaite, D. W., Meislin, H. W., Levine, R. J., & Guisto, J. A. (1996). Analysis of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act.. Annals of emergency medicine, 28(1), 45-50. doi:10.1016/s0196-0644(96)70138-5
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  To identify the incidence of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act (COBRA)..Under the Freedom of Information Act, we retrieved a copy of any document related to fines imposed on, settlements made by, or litigation against physicians or hospitals as a result of COBRA violations from the Office of the Inspector General. Under a separate inquiry, also under the Freedom of Information Act, we requested and received from the central office of the Health Care Financing Administration the National Composite Log showing the status of all complaint investigations pursuant to COBRA since the inception of the law..One thousand seven hundred fifty-seven complaint investigations were authorized. Of the 1,729 investigations completed, 412 (24%) were found to be out of compliance with federal regulations. Of these, 27 cases resulted in fines imposed on hospitals. These fines ranged from $1,500 to $150,000 with a mean of $33,917, a median of $25,000, and standard deviation of $35,899. The six fines that were imposed against physicians ranged in value from $2,500 to $20,000 with a mean of $8,500, a median of $7,500, and an SD of $8,612. Seven hospitals but no physicians were terminated from the Medicare program for COBRA violations..The incidence of federally imposed penalties for COBRA violations is low given the multitude of patient transfers that have occurred since the enactment of COBRA. The growing concern regarding this issue may be related to current litigation efforts to broaden the scope and applications of these laws.
• Verdile, V. P., Swor, R. A., Spaite, D. W., & Krohmer, J. R. (1996). Model curriculum in emergency medical services for emergency medicine residency programs. SAEM Emergency Medical Services Committee.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 3(7), 716-22. doi:10.1111/j.1553-2712.1996.tb03497.x
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  An emergency medical services (EMS) curriculum, as developed by the SAEM Emergency Medical Services Committee, is provided for the training of emergency medicine residents in EMS.
• Guisto, J., Valenzuela, T. D., Spaite, D. W., Guisto, J., & Criss, E. A. (1995). Emergency medical service systems research: problems of the past, challenges of the future.. Annals of emergency medicine, 26(2), 146-52. doi:10.1016/s0196-0644(95)70144-3
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  Out-of-hospital emergency care was designed around the concept of a system of interrelated events that combine to offer a patient the best care possible outside the hospital. However, in contrast to the actual operations of emergency medical service (EMS) systems, research has not typically used systems-based models as the method for evaluation. In this discussion we outline the weaknesses of component-based research models in EMS evaluation and attempt to provide a "systems-analysis" framework that can be used for future research. Incorporation of this multidiscipline approach into EMS research is essential if there is to be any hope of finding answers to many of the important questions that remain in the arena of out-of-hospital health care.
• Meislin, H. W., Weist, D. J., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Judkins, D., & Criss, E. A. (1995). A prospective investigation of the impact of alcohol consumption on helmet use, injury severity, medical resource utilization, and health care costs in bicycle-related trauma.. The Journal of trauma, 38(2), 287-90. doi:10.1097/00005373-199502000-00028
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  To examine if a relationship exists between bicycle-related injuries, consumption of alcohol, helmet use, and medical resource utilization..A prospective cohort study with data from emergency department, operating room, and inpatient records..University-based trauma center in a medium-sized metropolitan area..Adult victims (age > or = 18 years) of bicycle-related injury presenting to the emergency department. A total of 350 patients made up the study population..Group 1 consisted of 29 patients (8.3%) with detectable blood alcohol levels at the time of the incident. Group 2 (321 patients) had a measured blood alcohol level of 0 or no clinical indication of alcohol consumption. Group 1 mean Injury Severity Score was 10.3, with six (20.7%) sustaining at least one severe anatomic injury. Group 2 had an Injury Severity Score of 3.3 (p < 0.0001), with only 4.4% (p = 0.0013) sustaining severe anatomic injury. Mean length of hospitalization for group 1 was 3.5 days, including a mean of 1.4 intensive care unit days. Mean hospitalization (0.5 days, p < 0.0001) and intensive care unit (0.1 days, p < 0.0001) were significantly lower in group 2. Mean combined hospital and physician charges were more than six times greater for group 1 ($7,206) than group 2 patients ($1170, p < 0.0001)..In patients presenting with bicycle-related injuries, prior consumption of alcohol is highly associated with greater injury severity, longer hospitalization, and higher health care costs. This information is useful in the development of injury prevention strategies to decrease incidence and severity of adult bicycle injuries.
• Meislin, H. W., Wright, A. L., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Levine, R. M., & Criss, E. A. (1995). Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated i.v. lines.. Annals of emergency medicine, 25(4), 502-6. doi:10.1016/s0196-0644(95)70266-0
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  To compare the risk of infection for i.v. lines placed in the prehospital versus in the in-hospital setting in a midsized emergency medical service system..A retrospective analysis was made of all i.v. line site infections among patients admitted to ward beds from a university hospital emergency department in 1992..The hospital's infection control team conducted daily ward rounds and a surveillance of all wound and blood cultures. Patients with signs and/or symptoms consistent with Centers for Disease Control and Prevention guidelines for skin and soft tissue infection were reported to the responsible medical team. Infections were documented based on consensus opinion between the infection control team and the physicians responsible for the care of the patient. IV lines placed in the prehospital phase of care were identified by electronic retrieval from the prehospital database..Three thousand one hundred eighty-five patients who had a prehospital or an in-hospital i.v. line placed were admitted from the ED. Eight hundred fifty-nine i.v. lines were prehospital placed (27%), and 2,326 were in-hospital placed (73%). There was one infection in the prehospital group and four in the in-hospital group (infection rate: .0012 for prehospital patients and .0017 for in-hospital patients; P = .591 by Fisher's exact test)..Both cohorts had exceptionally low infection rates. No clinically or statistically significant increase in the risk of infection among prehospital- or in-hospital-initiated i.v. lines was identified.
• Spaite, D. W. (1995). Effectiveness of basic life support defibrillation.. Annals of emergency medicine, 25(5), 697-8.
• Spaite, D. W., & Maio, R. F. (1995). Using epidemiologic methods to evaluate out-of-hospital care: the ecologic study.. Annals of Emergency Medicine, 26(2), 153-157. doi:10.1016/s0196-0644(95)70145-1
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  Abstract [Maio RF, Spaite D: Using epidemiologic methods to evaluate out-of-hospital care: The ecologic study. Ann Emerg Med August 1995;26:153-157.]
• Yano, E. M., Spaite, D. W., Ryan¶, S., Ryan, S. D., Pollock, D. A., Kaufmann, C. R., Glass¶, C., Glass, C., Dawson-, D., Dawson, D. E., Cales, R. H., Brown, D. E., & Benoit, R. M. (1995). Uniform prehospital data elements and definitions: a report from the uniform prehospital emergency medical services data conference.. Annals of emergency medicine, 25(4), 525-34. doi:10.1016/s0196-0644(95)70271-7
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  One of the district and universal aspects of emergency medical service (EMS) is the belief that before its implementation many people were dying or being killed by ill-equipped, poorly trained "hearse drivers" and that this tragic state of affairs has been rectified by the advances in the prehospital phase of care. Except for cases of nontraumatic, out-of-hospital cardiac arrest there is almost no convincing scientific evidence to prove that prehospital care has had an impact on morbidity or mortality. At the very foundation of this problem is the lack of a set of broad-based, well-conceived, accurate, reliable, uniform EMS data. Many attempts have been made to develop a uniform EMS data set, but without a national consensus these have not achieved wide distribution. In 1992, with the assistance of the National Highway Traffic Safety Administration, the national consensus process began with a series of meetings involving many EMS agencies and organizations. This culminated in August 1994 with the development of an 81-item uniform EMS data set. We detail the prior attempts at data set development and outline the process leading to the this uniform, national EMS data set.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Hinsberg, P., & Criss, E. A. (1994). A prospective in-field comparison of intravenous line placement by urban and nonurban emergency medical services personnel.. Annals of emergency medicine, 24(2), 209-14. doi:10.1016/s0196-0644(94)70132-6
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  Emergency medical services personnel are highly proficient at rapid i.v. line placement in the prehospital setting, with little difference between urban and nonurban areas in a geographically diverse state..Prospective evaluation by an in-field observer of timing, sequence, success rates, and patient characteristics for IV line placement by prehospital personnel for 1 year..Twenty advanced life support agencies from all four emergency medical service regions of Arizona..Fifty-eight patients encountered by participating emergency medical service agencies who had at least one i.v. line placement attempt in the prehospital setting..Urban agencies encountered 24 patients (41.4%), and nonurban agencies encountered 34 (58.6%). Fifty-seven of 58 patients (98.3%) had at least one successful i.v. line started before arrival at a hospital. All 24 urban patients and 33 of 34 nonurban patients (97.1%) had a successful i.v. line attempt (P = .586, power = .09). In the urban setting, 24 of 31 attempts (77.4%) were successful, and in the nonurban setting 35 of 52 attempts (67.3%) were successful (P = .464, power = .28). Mean i.v. line procedure intervals were 1.6 minutes in urban and 1.4 minutes in nonurban settings (P = .408, power = .7). Thirty of 31 i.v. line attempts (96.7%) were completed in less than 4 minutes in urban systems, and 49 of 52 IV line attempts (94.2%) were completed in less than 4 minutes in nonurban systems (P = .520, power = .13). Mean i.v. line procedure intervals were 1.3 minutes for successful attempts and 2.1 minutes for unsuccessful ones (P = .015). Mean i.v. line procedure intervals for on-scene attempts were 1.3 minutes compared with 2.0 minutes for attempts during transport (P = .005). On average, i.v. line attempts in trauma patients took only 1.0 minutes compared with 1.7 in medical patients (P = .017)..Personnel in the 20 advanced life support agencies studied were extremely adept (rate of 98.3%) at obtaining i.v. line access in the prehospital setting. The time required to complete i.v. line placement was very short, and little difference was noted between urban and nonurban providers. I.v. procedure intervals were shorter for successful attempts, on-scene attempts, and attempts in trauma patients compared with their counterparts.
• Meislin, H. W., Wright, A. L., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Levine, R. M., & Criss, E. A. (1994). Comparison of Clinically Significant Infection Rates Among Prehospital Versus In-hospital Initiated Intravenous lines. Prehospital and Disaster Medicine, 9(S2), S53-S53. doi:10.1017/s1049023x00050093
• Spaite, D. W., Criss, E. A., & Valenzuela, T. D. (1994). Issues involved in the air medical transport of trauma victims: Air versus ground transport. Top Emerg Med, 16, 75-82.
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  Spaite DW, Criss EA, Valenzuela TD: Issues involved in the air medical transport of trauma victims: Air versus ground transport. Top Emerg Med 1994;16:75-82
• Valenzuela, T. D., Spaite, D. W., Judkins, D., Jarrell, B. E., Hampton, D. R., Fritz, M., & Clark, L. L. (1994). Relative Risk of Injury by Hispanic Status. Prehospital and Disaster Medicine, 9(S2), S52-S52. doi:10.1017/s1049023x00050081
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., & Meislin, H. W. (1993). Barriers to EMS system evaluation problems associated with field data collection. Prehospital and Disaster Medicine, 8(1), S35-S40. doi:10.1017/s1049023x00067509
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  For more than two decades, emergency medical services (EMS) systems have proliferated primarily based upon governmental impetus and funding at the federal, state, and local levels. Although many of the foundations of patient care rendered in these systems have been based upon intuitive logic, the understanding of the impact on patient outcome is poor, at best. The reasons for the current status are varied, but five issues are preeminent:1) The authority for the development of these medical systems has been based primarily in political and bureaucratic institutions which have little or no medical expertise;2) Little attention has been paid to system evaluation, particularly in the area of cost-effectiveness;3) Few academic medical institutions have become involved in EMS research;4) Traditional approaches to medical research primarily are disease-specific and are not multidisciplinary. Thus these are not useful for evaluating and understanding the highly complex and uncontrolled environmental interactions that typify EMS systems; and5) The process of efficiently and reliably collecting accurate data in the prehospital setting is extremely difficult.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., & Meislin, H. W. (1993). Physician in-field observation of prehospital advanced life support personnel: a statewide evaluation.. Prehospital and disaster medicine, 8(4), 299-302. doi:10.1017/s1049023x00040541
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  Direct physician observation of advanced life support (ALS) personnel is rare in a demographically diverse state..Twenty ALS agencies from throughout Arizona..A board-certified emergency physician performed on-site interviews with the emergency medical services (EMS) supervisor of each agency to approximate the number of days per year that physicians observe ALS personnel in the field..Only 11 agencies (55%) reported that physicians ever observed ALS personnel. Among all agencies, an estimated total of 84 observer-days occurred per year. The agencies staffed a total of 86 ALS units, resulting in an estimated 0.98 observer-days/unit/year (84/86). On the average, it took 3.4 ALS personnel to staff a given unit over time and the probability that an ALS provider would be on a unit on any given day was 0.29 (1/3.4). The probability of a given provider being observed during one year was approximately 0.29 (0.98 x 0.29). Thus, on the average, an ALS provider would be observed by a physician approximately once every 3.5 years (1/0.29). Among urban agencies, the "average" ALS provider would be observed once every 2.9 years. This compared to a likelihood of in-field observation of only once every 6.7 years for non-urban providers (p = .036)..The skills of ALS providers in Arizona are observed by a physician in the field very infrequently. Although an uncommon occurrence in urban agencies, observation of non-urban ALS personnel occurs even less frequently. In addition, nearly one-half of the agencies surveyed never had a physician-observer. Although a variety of skills evaluation methods exist, it remains unclear whether any method is as useful as direct observation. Future investigations are needed to evaluate whether in-field physician observation impacts skills, patient care, or outcome in EMS systems.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Hinsberg, P., & Criss, E. A. (1993). Prospective validation of a new model for evaluating emergency medical services systems by in-field observation of specific time intervals in prehospital care.. Annals of emergency medicine, 22(4), 638-45. doi:10.1016/s0196-0644(05)81840-2
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  To develop and validate a new time interval model for evaluating operational and patient care issues in emergency medical service (EMS) systems. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective analysis of 300 EMS responses among 20 advanced life support agencies throughout an entire state by direct, in-field observation..Mean times (minutes) were response, 6.8; patient access, 1.0; initial assessment, 3.3; scene treatment, 4.4; patient removal, 5.5; transport, 11.7; delivery, 3.5; and recovery, 22.9. The largest component of the on-scene interval was patient removal. Scene treatment accounted for only 31.0% of the on-scene interval, whereas accessing and removing patients took nearly half of the on-scene interval (45.8%). Operational problems (eg, communications, equipment, uncooperative patient) increased patient removal (6.4 versus 4.5; P = .004), recovery (25.4 versus 20.2; P = .03), and out-of-service (43.0 versus 30.1; P = .007) intervals. Rural agencies had longer response (9.9 versus 6.4; P = .014), transport (21.9 versus 10.3; P < .0005), and recovery (29.8 versus 22.1; P = .049) interval than nonrural. The total on-scene interval was longer if an IV line was attempted at the scene (17.2 versus 12.2; P < .0001). This reflected an increase in scene treatment (9.2 versus 2.8; P < .0001), while patient access and patient removal remained unchanged. However, the time spent attempting IV lines at the scene accounted for only a small part of scene treatment (1.3 minutes; 14.1%) and an even smaller portion of the overall on-scene interval (7.6%). Most of the increase in scene treatment was accounted for by other activities than the IV line attempts..A new model reported and studied prospectively is useful as an evaluative research tool for EMS systems and is broadly applicable to many settings in a demographically diverse state. This model can provide accurate information to system researchers, medical directors, and administrators for altering and improving EMS systems.
• Meislin, H. W., Valenzuela, T. D., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Keim, S. M., & Brown, J. F. (1993). Penetrating Trauma: Severity, Cost, and Reimbursement. Prehospital and Disaster Medicine, 8(S3), S130-S130. doi:10.1017/s1049023x00048615
• Meislin, H. W., Wright, A. L., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Ewy, G. A., & Clark, L. L. (1993). Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: monitoring emergency medical services system performance in sudden cardiac arrest.. Annals of emergency medicine, 22(11), 1678-83. doi:10.1016/s0196-0644(05)81305-8
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  To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest..A 22-month case series, collected prospectively, of out-of-hospital cardiac arrests. Times of collapse, dispatch, scene arrival, CPR, and initial defibrillation were determined from dispatch records, recordings of arrest events, interviews with bystanders, and hospital records..Southwestern city (population, 400,000; area, 390 km2) with a two-tiered basic life support-advanced life support emergency medical services system. Emergency medical technician-firefighters without electrical defibrillation capability comprised the first response tier; firefighter-paramedics were the second tier..One hundred eighteen cases of witnessed, out-of-hospital cardiac arrest in adults with initial ventricular fibrillation..Survival was defined as a patient who was discharged alive from the hospital..Eighteen of 118 patients (15%) survived. Survivors did not differ significantly from nonsurvivors in age, sex, or basic life support or advanced life support response intervals. Survivors had significantly (P < .05) shorter intervals from collapse to CPR (1.7 versus 5.2 minutes) and to defibrillation (7.4 versus 9.5 minutes)..Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.
• Spaite, D. W. (1993). Cricothyrotomy performed by prehospital personnel.. The American journal of emergency medicine, 11(3), 310. doi:10.1016/0735-6757(93)90149-6
• Spaite, D. W. (1993). Outcome analysis in EMS systems.. Annals of emergency medicine, 22(8), 1310-1. doi:10.1016/s0196-0644(05)80113-1
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  See related article, p 1258. Enormous advances in the structure and sophistication of emergency medical services (EMS) systems have occurred during the past two decades. However, little is known about the effect of prehospital interventions on patient outcome. Despite a plethora of EMS "research," only two specific interventions have been proven to impact outcome in any prehospital patient population (early CPR and early defibrillation in the setting of out-of-hospital, nontraumatic cardiac arrest). Given the expense and complexity of establishing and maintaining prehospital care systems, it has become clear that the single most important current need in EMS is the proper scientific evaluation of the impact of prehospital interventions on patient outcome. In this issue, Lindbeck and associates deal with such an issue. In their evaluation of victims of out-ofhospital, nontraumatic cardiac arrest transported by helicopter, they report a 1% survival to hospital discharge. In this survivor, successful resuscitation already had been accomplished by ground-based advanced life support (ALS) personnel before the arrival of the helicopter. This finding has led to an alteration in the use of air medical resources for this problem within their system. Under certain circumstances, it appears that the use of air medical resources will have improved efficiency with a very low risk for withholding a potentially beneficial intervention. For this, the authors are to be applauded. How this investigation ought to affect the use of air medical resources in other EMS systems, however, should not follow immediately from these data. Attempting to interpret how prehospital outcome studies in one system should impact others is an important but precarious pathway. This is highlighted by the fact that the patient population in this study had an expected probability of survival of essentially zero regardless of what interventions occurred. This is so
• Spaite, D. W., Pons, P. T., Mcdowell, R., Krohmer, J. R., & Benson, N. (1993). Guidelines for implementation of early defibrillation/automated external defibrillator programs. American College of Emergency Physicians.. Annals of emergency medicine, 22(4), 740-1. doi:10.1016/s0196-0644(05)81860-8
• Valenzuela, T. D., Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Geare, E. A., & Criss, E. A. (1993). Prospective Analysis of the Impact of Transport Interval on Prehospital Advanced Airway Procedures in Severely Injured Trauma Victims. Prehospital and Disaster Medicine, 8(S2), S58-S58. doi:10.1017/s1049023x00049657
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., & Meislin, H. W. (1992). Meeting the goals of academia: characteristics of emergency medicine faculty academic work styles.. Annals of emergency medicine, 21(3), 298-302. doi:10.1016/s0196-0644(05)80891-1
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  Emergency medicine faculty have 24-hour clinical responsibilities in addition to the academic requirements of research and administration/teaching. This study was undertaken to determine the existing and ideal work style of such faculty by professional rank, administrative title, and/or tenure versus clinical track..Data analysis from department or residency directors of Accreditation Council for Graduate Medical Education-approved emergency medicine residency programs..ACGME-approved emergency medicine residency programs..Emergency medicine faculty..Ninety-three percent of programs submitted appropriate data. Programs averaged 11 full- and four part-time faculty. Mean time ranged from 15 to 30 hours per week with an average mean of 23 hours (48% of total work week) for clinical responsibilities, from ten to 32 hours per week with an average mean of 19 hours per week (38%) for administrative/teaching efforts, and from three to 14 hours per week with an average mean of seven hours per week (15%) for research. Total time averaged between 44 and 51 hours per week. Ideal work style emphasized less clinical time and a shorter work week. Responsibilities varied by rank, administrative position, and clinical versus tenure track..Emergency medicine faculty accomplish the clinical, research, and teaching/administrative demands of academia by increasing the number of faculty, varying the faculty responsibilities by rank and title, and shortening the total work week. Research time is extremely limited.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Hinsberg, P., Criss, E. A., & Brophy, T. (1992). A New Model for Evaluating the Impact of Major System Changes on Emergency Air Medical Scene Responses in a Regional EMS System. Prehospital and Disaster Medicine, 7(1), 19-23. doi:10.1017/s1049023x00039157
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  Hypothesis:Centralized dispatch data can provide useful information regarding the impact of major air medical system changes in a regional emergency medical services (EMS) system.Methods:Prospective evaluation of helicopter dispatch data from a centralized EMS dispatch agency. During the study period, four alterations in the total number of helicopters available to the system occurred (1,2,3,2,3). Statistical analysis consisted of Chi-Square with Yates' correction and comparison of sample proportions with p
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Ross, J., Meislin, H. W., & Criss, E. A. (1992). A Prospective Evaluation of the Impact of Initial Glasgow Coma Score on Prehospital Treatment and Transport of Seizure Patients. Prehospital and Disaster Medicine, 7(2), 127-132. doi:10.1017/s1049023x00039352
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  Hypothesis:The initial Glasgow Coma Score (GCS) obtained by prehospital personnel on seizure victims is associated with the likelihood of treatment and transport.Methods:Prehospital data were collected prospectively for all patients presenting with seizures to a mid-sized emergency medical services system during a five-month period. A total of 419 cases occurred (62.8% male, 37.2% female). Seizure frequency was highest in infants under the age of three years and in adults in their late 20s. A GCS was recorded in 378 cases (90.2%, study group). The GCS was >10 in 304 patients (80.4%) and ≤10 in 74 (19.6%). Patients with GCS≤10 were more likely to receive: oxygen (50.0% vs. 20.1%, p 10. However, the clinical indicators that were used to make the decision that it was “safe” not to transport nearly one-third of the patients are unclear. Essentially no data exist regarding the parameters impacting treatment and transport of seizure patients. Future investigations with outcome data, are needed to determine whether low risk criteria can be developed to identify those patients (if any) that do not require treatment or transport. A GCS may provide an objective, reproducible parameter upon which to begin formulating such criteria.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Sayre, R. O., Meislin, H. W., & Clark, L. L. (1992). Estimated Cost-Effectiveness of Dispatcher CPR Instruction via Telephone to Bystanders During Out-of-Hospital Ventricular Fibrillation. Prehospital and Disaster Medicine, 7(3), 229-233. doi:10.1017/s1049023x00039558
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  Hypothesis:Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technician (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VF) in adult patients.Methods:A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms.Results:Of the 53 patients receiving bystander CPR (BCPR), 14 (26%) survived to hospital discharge versus 4/65 patients (6%) lacking BCPR, These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US]$560 in patients experiencing out-of-hospital ventricular fibrillation.Conclusion:The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.
• Meislin, H. W., Wright, A. L., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Ewy, G. A., & Clark, L. (1992). Case and survival definitions in out-of-hospital cardiac arrest. Effect on survival rate calculation.. JAMA, 267(2), 272-274. doi:10.1001/jama.1992.03480020082036
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  Objective. —To determine the effect of different case and survival definitions of out-of-hospital cardiac arrest on survival rate calculations. Design. —A 22-month case series of nontraumatic, out-of-hospital cardiac arrests. Setting. —Southwestern city (population, 400000; area, 390 km2) with a two-tiered emergency response system consisting of emergency medical technicians and paramedics. Patients. —A consecutive sample of 372 patients found without palpable pulse or spontaneous respiration. Main Outcome Measures. —Survival rate after cardiac arrest was calculated using three case definitions of arrest and two definitions of survival. Results. —Twenty percent of all patients survived to hospital admission and 6% survived to hospital discharge. Twenty-six percent of adults whose collapse was witnessed survived to hospital admission, and 10% survived to hospital discharge. Patients whose collapse was witnessed and who experienced initial ventricular fibrillation survived to hospital admission in 38% and to hospital discharge in 15% of cases. Conclusions. —The survival rate after out-of-hospital cardiac arrest varies widely depending on the case and survival definitions selected. To facilitate intersystem comparison and assessment of interventions designed to improve outcome, the Utstein Consensus Conference recommended that case and survival definitions should be adopted by all prehospital emergency systems. (JAMA. 1992;267:272-274)
• Spaite, D. W., Murphy, M. E., & Criss, E. A. (1992). A PROSPECTIVE ANALYSIS OF INJURY SEVERITY AMONG HELMETED AND NONHELMETED BICYCLISTS INVOLVED IN COLLISIONS WITH MOTOR VEHICLES. Journal of Pediatric Orthopaedics, 12(3), 420. doi:10.1097/01241398-199205000-00074
• Spaite, D. W., Smith, R., & Sanders, A. B. (1992). Erratum: Meeting the goals of academia: Characteristics of emergency medicine faculty academic work styles (J Emerg Med (1988) 6 (435-437)). Annals of Emergency Medicine, 21(6), 763. doi:10.1016/s0196-0644(05)82801-x
• Wright, A. L., Valenzuela, T. D., Spaite, D. W., Schaffer, J. A., Goldman, S., Clark, L., & Brakema, R. M. (1992). Emergency Physician Interpretation of Prehospital, Paramedic-Acquired Electrocardiograms. Prehospital and Disaster Medicine, 7(3), 251-255. doi:10.1017/s1049023x00039583
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  Hypothesis: Emergency physician interpretation of prehospital, paramedic-acquired, electrocardiograms (ECG) is accurate judged by comparison with that of a reference cardiologist. Methods: Twelve-lead ECGs were obtained by paramedics in the field from 150 patients with acute chest pain. The ECGs were transmitted by cellular telephone to a central location. Each ECG was assessed for evidence of acute myocardial infarction (AMI) by: 1) a third-year, emergency medicine resident (EMP-R); 2) a residency-trained, board-certified, emergency physician (EMP-RT); 3) an emergency physician board certified under the practice option (EMP-PT); and 4) a board-certified cardiologist. Agreement between each emergency physician and the cardiologist was assessed by the kappa statistic. Hospital records were reviewed for final diagnosis of each patient. Results: Sixteen of 150 (10.7%) patients received a hospital discharge diagnosis of AMI. Sensitivity of physician interpretation ranged from 0.31 to 0.56. All physicians achieved specificity of 0.99. False-positive rates for the physicians ranged from 0.18–0.29. The mean positive predictive value for the four physicians was 0.77±0.05; the mean negative predictive value was 0.94±0.01. The total agreements between the EMP-R, EMP-RT, and EMP-PT and the cardiologists were 0.97, 0.96, and 0.97, respectively. Kappa values for agreement between the emergency physicians and the cardiologist ranged from 0.65–0.79. Conclusions: Residency-trained or board-certified emergency physician interpretations of prehospital, paramedic-acquired 12-lead ECGs show a high degree of agreement with reference cardiologist interpretations.
• Meislin, H. W., Spaite, D. W., Meislin, H. W., Hinsberg, P., D, V. T., & Criss, E. A. (1991). Spaite et al Responds. Prehospital and Disaster Medicine, 6(1), 76-76. doi:10.1017/s1049023x00028144
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Murphy, M. E., Meislin, H. W., & Criss, E. A. (1991). A prospective analysis of injury severity among helmeted and nonhelmeted bicyclists involved in collisions with motor vehicles.. The Journal of trauma, 31(11), 1510-6. doi:10.1097/00005373-199111000-00008
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  To evaluate the impact of helmet use on injury severity, patient information was prospectively obtained for all bicyclists involved in collisions with motor vehicles seen at a level-I trauma center from January 1986 to January 1989. Two hundred ninety-eight patients were evaluated; in 284 (95.3%, study group) cases there was documentation of helmet use or nonuse. One hundred sixteen patients (40.9%) wore helmets and 168 (59.1%) did not. One hundred ninety-nine patients (70.1%) had an ISS less than 15, while 85 (29.9%) were severely injured (ISS greater than 15). Only 5.2% of helmet users (6/116) had an ISS greater than 15 compared with 47.0% (79/168) of nonusers (p less than 0.0001). The mean ISS for helmet users was 3.8 compared with 18.0 for nonusers (p less than 0.0001). Mortality was higher for nonusers (10/168, 6.0%) than for helmet users (1/116, 0.9%; p less than 0.025). A striking finding was noted when the group of patients without major head injuries (246) was analyzed separately. Helmet users in this group still had a much lower mean ISS (3.6 vs. 12.9, p less than 0.001) and were much less likely to have an ISS greater than 15 (4.4% vs. 32.1%, p less than 0.0001) than were nonusers. In this group, 42 of 47 patients with an ISS greater than 15 (89.4%) were not wearing helmets. We conclude that helmet nonuse is strongly associated with severe injuries in this study population. This is true even when the patients without major head injuries are analyzed as a group; a finding to our knowledge not previously described.(ABSTRACT TRUNCATED AT 250 WORDS)
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Ross, J., Meislin, H. W., & Criss, E. A. (1991). Analysis of Prehospital Scene Time and Survival from Out-of-Hospital, Non-Traumatic, Cardiac Arrest. Prehospital and Disaster Medicine, 6(1), 21-27. doi:10.1017/s1049023x00028028
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  AbstractThe purpose of this study was to determine whether shorter prehospital scene time (ST) is associated with an increased survival rate in non-traumatic, out-of-hospital, cardiac arrest (CA) in a medium-sized, metropolitan EMS system. Information was retrieved for all adult victims (age ≥18 years) of CA treated and transported by a metropolitan fire department over a 16month period (6/87–9/88). Data were retrieved from the fire department's database, hospital records, and death certificates. Statistical analysis of continuous variables was performed using the two-tailed, Student's t-test and non-parametric evaluations were performed by square analysis with p
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Ross, J., Meislin, H. W., Hanlon, T., & Criss, E. A. (1991). Prehospital data entry compliance by paramedics after institution of a comprehensive EMS data collection tool. Resuscitation, 21(1), 109. doi:10.1016/0300-9572(91)90095-g
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  Objective: To determine the completeness of data entry by paramedics after an extensive modification of the prehospital first-care form in an urban emergency medical services (EMS) system. Design: Comprehensive medical information was added to the EMS data collection tool used by a metropolitan fire department. We evaluated the frequency of failure to enter data pertaining to medical assessment and/or treatment of victims of cardiac arrest after implementation of the system. Results: Failure to enter data in the first month was compared with two subsequent two-month blocks. A high rate of noncompliance existed in the first month (all medical data were missing in 24.6%). However, the subsequent two months revealed a marked decline in noncompliance (4.4%, P P Conclusion: Data entry noncompliance can be a significant problem after implementation of a new prehospital data collection system. However, compliance can be markedly improved over a relatively short period. Because EMS system evaluation is based on data collected in the field, EMS researchers and administrators must be aware of the data entry compliance rate in their system when attempting to make conclusions from such information.
• Meislin, H. W., Valenzuela, T. D., Tse, D. J., Spaite, D. W., Ross, J., Meislin, H. W., Mahoney, M., & Criss, E. A. (1991). The impact of injury severity and prehospital procedures on scene time in victims of major trauma.. Annals of emergency medicine, 20(12), 1299-305. doi:10.1016/s0196-0644(05)81070-4
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  To evaluate the relationship among injury severity, prehospital procedures, and time spent at the scene by paramedics for victims of major trauma..Retrospective study of 98 consecutive patients with an Injury Severity Score of more than 15 who were brought to a trauma center by fire department paramedics..A medium-sized metropolitan emergency medical services (EMS) system and a Level I trauma center..There were 66 male and 32 female patients with a mean age of 34 years. Thirty-two patients (32.6%) died. Blunt and penetrating trauma accounted for 68.4% and 31.6% of cases, respectively. Thirty-three patients (33.7%) had successful advanced airway procedures, and 81 (82.7%) had at least one IV line started in the field. Analysis of scene time, prehospital procedures, and injury severity parameters revealed that more procedures were performed in the field on the more severely injured cases; that despite this, there was a trend toward shorter scene time for more severely injured patients; and that there was a mean scene time of 8.1 minutes. This is the shortest scene time reported to date for prehospital trauma care in an EMS system..Extremely short scene times can be attained without foregoing potentially life-saving advanced life support interventions in an urban EMS system with strong medical control. In such a system, the most severely injured victims may spend less time at the scene although more procedures are performed on them.
• Meislin, H. W., Wright, A. L., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Keeley, K. T., Hanlon, T., & Criss, E. A. (1991). Prehospltal cardiac arrest: The Impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times. Resuscitation, 21(1), 109-110. doi:10.1016/0300-9572(91)90096-h
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Hinsberg, P., & Criss, E. A. (1990). A Prospective Evaluation of Prehospital Patient Assessment by Direct In-field Observation: Failure of ALS Personnel to Measure Vital Signs. Prehospital and Disaster Medicine, 5(4), 325-333. doi:10.1017/s1049023x00027060
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  We prospectively evaluated the frequency with which advanced life support (ALS) personnel fail to attempt to measure blood pressure (BP) and/or pulse (P) during prehospital patient assessment. A single in-field observer rode on ALS rescue vehicles from 20 Emergency Medical Services (EMS) agencies throughout Arizona during a one-year study (1/89–12/89). Data were collected from urban, suburban, and rural systems. Statistical evaluation was performed by Chi Square analysis with p
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Ross, J., Meislin, H. W., & Criss, E. A. (1990). Geriatric injury: an analysis of prehospital demographics, mechanisms, and patterns.. Annals of emergency medicine, 19(12), 1418-21. doi:10.1016/s0196-0644(05)82611-3
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  To evaluate emergency medical services (EMS) system use, injury mechanisms, and prehospital assessments among elderly victims of trauma..We analyzed all prehospital data for injuries among patients 70 years old or older for whom 911 EMS dispatch was requested in a medium-sized metropolitan area during a 12-month period..A total of 1,154 cases occurred (women, 65.1%), which represented 30.3% of all 911 dispatches involving elderly patients. Injury mechanisms were fall (60.7%), motor vehicle accident (MVA; 21.5%), fight (2.4%), accidental poisoning (2.3%), and choking (2.1%). Persons in their 90s had a lower frequency of MVAs (3.4%) than did younger patients (23.0%) (P less than .005). The most frequent injuries determined by prehospital assessment were head or face (25.1%), upper extremity (17.2%), hip (14.5%), lower extremity (13.8%), back (9.8%), and chest or abdomen (5.0%). The frequency of serious neurologic injuries was less for falls or MVAs than for other mechanisms (P less than .005). Suspected hip (P less than .001) and pelvic (P less than .005) injuries occurred more frequently during falls than during other mechanisms of injury, whereas back injuries occurred most frequently in MVAs (P less than .001). Seventy-one fall victims (10.1%) had suspected medical causes of their fall. Twelve patients (1.0%) were in cardiac arrest..We report injury patterns and mechanisms among elderly victims of trauma presenting to an EMS system. A knowledge of these patterns will be useful to emergency physicians and EMS administrators.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Ross, J., Meislin, H. W., Hanlon, T., & Criss, E. A. (1990). Prehospital data entry compliance by paramedics after institution of a comprehensive EMS data collection tool.. Annals of emergency medicine, 19(11), 1270-3. doi:10.1016/s0196-0644(05)82286-3
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  To determine the completeness of data entry by paramedics after an extensive modification of the prehospital first-care form in an urban emergency medical services (EMS) system..Comprehensive medical information was added to the EMS data collection tool used by a metropolitan fire department. We evaluated the frequency of failure to enter data pertaining to medical assessment and/or treatment of victims of cardiac arrest after implementation of the system..Failure to enter data in the first month was compared with two subsequent two-month blocks. A high rate of noncompliance existed in the first month (all medical data were missing in 24.6%). However, the subsequent two months revealed a marked decline in noncompliance (4.4%, P less than .001). This decline was maintained after a three-month interim (5.0%, P less than .001)..Data entry noncompliance can be a significant problem after implementation of a new prehospital data collection system. However, compliance can be markedly improved over a relatively short period. Because EMS system evaluation is based on data collected in the field. EMS researchers and administrators must be aware of the data entry compliance rate in their system when attempting to make conclusions from such information.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Smith, R., Nelson, A., Meislin, H. W., & Criss, E. A. (1990). Banning alcohol in a major college stadium: impact on the incidence and patterns of injury and illness.. Journal of American college health : J of ACH, 39(3), 125-8. doi:10.1080/07448481.1990.9936223
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  To evaluate the effect of banning alcohol on the incidence of injuries and illness among spectators, we reviewed 4 years (1983 to 1986) of medical incident reports from a major collegiate football stadium. At no time had alcoholic beverages been sold inside the stadium, but before 1985, fans were allowed to bring alcohol into the stadium. In 1985, this practice was banned. During the study period, 340 medical incidents (M = 12.6/game) were reported. Several alterations of specific injury/illness patterns were noted after initiation of the ban: heat-related illness occurred more frequently before initiation of the ban, whereas extremity injuries and syncope (fainting from coronary insufficiency) occurred with greater frequency afterwards. The injury/illness rates per 10,000 fans were 2.95 in 1983, 2.45 in 1984, 1.92 in 1985, and 3.48 in 1986. There was no significant change in the overall incident rate after the ban. Evaluation of medical incidents revealed an alteration in specific injury/illness patterns but no change in overall incidence after institution of the ban. Future investigations are needed to elucidate more clearly the impact of banning alcohol on injury/illness rates and patterns at mass gatherings.
• Meislin, H. W., Wright, A. L., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Criss, E. A., & Clark, L. (1990). Cost-effectiveness analysis of paramedic emergency medical services in the treatment of prehospital cardiopulmonary arrest.. Annals of emergency medicine, 19(12), 1407-11. doi:10.1016/s0196-0644(05)82609-5
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  1) Identification of marginal costs associated with prehospital resuscitation of cardiopulmonary arrest; 2) Determination of cost effectiveness for such resuscitation; and 3) Comparison of cost effectiveness of paramedic care with selected other medical interventions..Retrospective review of 190 cases of out-of-hospital cardiac arrest..City limits of a midsized southwestern city. The events studied took place outside of medical facilities..Victims of out-of-hospital cardiac arrest for whom the EMS system was activated by a 911 telephone request for emergency medical assistance..The cost, including training, personnel, equipment, and response time maintenance, per year of life saved was found to be $8,886.00 for paramedic care. This result was compared with published cost-effectiveness figures for heart transplantation, liver transplantation, bone marrow transplantation, and chemotherapy for acute leukemia. Paramedic care was more cost effective, as measured by cost per year of life saved, than organ transplantation and chemotherapy for acute leukemia..Out-of-hospital treatment by paramedics of cardiopulmonary arrest is more cost effective than heart, liver, bone marrow transplantation, or curative chemotherapy for acute leukemia.
• Meislin, H. W., Wright, A. L., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Keeley, K. T., Hanlon, T., & Criss, E. A. (1990). Prehospital cardiac arrest: the impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times.. Annals of emergency medicine, 19(11), 1264-9. doi:10.1016/s0196-0644(05)82285-1
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  Numerous studies have shown initiation of bystander CPR to significantly improve survival from prehospital cardiac arrest. However, in emergency medical services (EMS) systems with very short response times, bystander CPR has not been shown to impact outcome. The purpose of this study was to determine the effect of bystander CPR on survival from out-of-hospital cardiac arrest in such a system..Prehospital, hospital, and death certificate data from a medium-sized metropolitan area were retrospectively analyzed for adult, nontraumatic cardiac arrest during a 16-month period..A total of 298 patients met study criteria. One hundred ninety-five arrests (65.4%) were witnessed, and 103 (34.6%) were unwitnessed. Twenty-five witnessed victims (12.8%) were discharged alive, whereas no unwitnessed victims survived (P less than .001). Patients suffering a witnessed episode of ventricular fibrillation/tachycardia (VF/VT) were more likely to survive (21.9%) than were other patients (2.0%, P less than .0001). Among witnessed patients, initiation of bystander CPR was associated with a significant improvement in survival (20.0%) compared with the no-bystander CPR group (9.2%, P less than .05). Bystander CPR was also associated with improved outcome when witnessed patients with successful prehospital resuscitation were evaluated as a group; 18 had bystander CPR, of whom 13 (72.2%) survived compared with only 12 of 38 patients with no bystander CPR (31.6%, P less than .01)..Our data revealed improved survival rates when bystander CPR was initiated on victims of witnessed cardiac arrest in an EMS system with short response times.
• Spaite, D. W., Joseph, M., & Spait, D. W. (1990). Prehospital cricothyrotomy: an investigation of indications, technique, complications, and patient outcome.. Annals of emergency medicine, 19(3), 279-85. doi:10.1016/s0196-0644(05)82045-1
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  The records of all patients who presented to a Level 1 trauma center during a two-year period for whom a prehospital cricothyrotomy was attempted or ordered were reviewed. Twenty patients met the study criteria. The average age was 37 years (range, 11 to 65 years). Indications for prehospital cricothyrotomy were massive facial trauma (eight), failed oral intubation (seven), and suspected cervical-spine injury (one). Cricothyrotomy was attempted in 16 patients (80%), with the remaining four having the procedure ordered but not attempted. A successful airway was achieved in 14 patients (88%). Horizontal incisions were used in all cases and were anatomically correct in 15 of 16 attempts (94%). The overall immediate complication rate was 31%. Two patients (12%) sustained major complications (failure to obtain an airway). No hemorrhagic complications occurred, but 16 of the 20 were in cardiac arrest in the field. Long-term complications were not evaluated. All patients sustained major injuries (mean Injury Severity Score, 53.7), except one patient who suffered airway obstruction from food. Three patients (15%) survived; two of the three suffered permanent, severe brain dysfunction. These preliminary findings demonstrate that prehospital cricothyrotomy is being used chiefly in massively injured patients who are already beyond recovery. It is thus difficult to assess whether the procedure is either safe or effective. There is a need for further investigation to determine whether prehospital cricothyrotomy has any beneficial effect on outcome and, if so, in what setting.(ABSTRACT TRUNCATED AT 250 WORDS)
• Spaite, D. W., Robinson, W. A., Prosser, R. L., Hamilton, G. C., Binder, L. S., & Allison, E. J. (1990). 24-hour coverage in academic emergency medicine: ways of dealing with the issue.. Annals of emergency medicine, 19(4), 430-4. doi:10.1016/s0196-0644(05)82353-4
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., & Criss, E. A. (1989). Evaluation of EMS management training offered during emergency medicine residency training.. Annals of emergency medicine, 18(8), 812-4. doi:10.1016/s0196-0644(89)80201-x
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  Physician involvement in the provision of both direct and indirect medical control to emergency medical providers is critical to the effective operation of an emergency medical services (EMS) system. We conducted a survey of all accredited emergency medicine residency programs in the United States to determine the content of EMS instruction provided to these physicians-in-training. The majority of programs provide an introduction to direct medical control, to EMS organizational structure, and the opportunity to participate in EMS-related research. Less than 65%, however, provide formal instruction in EMS risk management or quality assurance or the opportunity to observe policy-making bodies related to EMS. The importance placed on EMS during residency training is variable. EMS is the domain of emergency medicine, and adequate training of residents for these responsibilities is imperative.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Facter, K., & Criss, E. A. (1989). Medical versus regulatory necessity: regulation of ambulance service in Arizona.. The Journal of emergency medicine, 7(3), 253-6. doi:10.1016/0736-4679(89)90356-9
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  Governmental regulation of emergency medical services and transportation differs from state to state. In Arizona, the Department of Health Services (ADHS) regulates the provision of ambulance service through a "certificate-of-necessity" (CON) process. Paramedic rescue services provided by municipalities are not, by statute, mandated to comply with these ADHS regulations. We review the way in which criteria for the determination of ambulance need were adopted by this state agency and the effects of their application in Tucson, Arizona. Approximately one million dollars and 5,500 unnecessary "code 3" (lights and siren activated) emergency vehicle trips were mandated by the ADHS need criteria, over a twelve-month period. We conclude that non-scientifically-derived regulatory criteria may conflict with prudent medical control of prehospital emergency medical services (EMS).
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Keeley, K. T., & Criss, E. A. (1989). Implementation of a computerized management information system in an urban fire department.. Annals of emergency medicine, 18(5), 573-8. doi:10.1016/s0196-0644(89)80847-9
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  An important aspect in the effective management of an emergency medical services system is the ability to monitor system performance. To provide this information on a timely basis, a comprehensive data collection system is required. We describe the design, implementation, use, and effect of a comprehensive, computerized data retrieval system within an urban fire department. Building on a data collection system already in place, it was possible to minimize the cost and accelerate the training process. A comparison is included between the different type of systems available for use with prehospital providers. Use of prehospital data collection systems results in more in-depth understanding of system operations and the status of prehospital medical care provided to the community.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Schram, K. H., Meislin, H. W., Hammargren, W. M., Criss, E. A., & Clark, J. B. (1989). Thermal stability of prehospital medications.. Annals of emergency medicine, 18(2), 173-6. doi:10.1016/s0196-0644(89)80109-x
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  To evaluate the effect of prolonged environmental extremes on common prehospital medications, four identical sets of 23 drugs were placed in a simulated environment for up to four weeks. Subsequently, the samples were analyzed by gas chromatography-mass spectrometry for evidence of degradation byproducts. Twenty-one of the 23 samples showed no breakdown products; however, isoproterenol demonstrated 11% loss of parent compound after four weeks of environmental exposure. Epinephrine manifested a change in its ionized state after exposure to heat; the physiologic effect of this change was not determined. Our results suggest that rural and suburban emergency medical services providers, whose medications may not be replaced until they are used in patient care, must monitor their drug boxes' duration of exposure to uncontrolled conditions.
• Valenzuela, T. D., Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Meislin, H. W., Goldberg, J., & Criss, E. A. (1989). Development of a computer model to predict EMS system performance after changes in number, location, and area of responsibility of EMS units. Annals of Emergency Medicine, 18(4), 438. doi:10.1016/s0196-0644(89)80625-0
• Valenzuela, T. D., Meislin, H. W., Valenzuela, T. D., Tse, D., Spaite, D. W., Meislin, H. W., Mahoney, M., & Criss, E. A. (1989). The association between scene time, prehospital procedures, and injury severity parameters among severely injured patients. Annals of Emergency Medicine, 18(4), 450. doi:10.1016/s0196-0644(89)80683-3
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Ogden, J. R., Meislin, H. W., & Criss, E. A. (1988). Railroad accidents: a metropolitan experience of death and injury.. Annals of emergency medicine, 17(6), 620-5. doi:10.1016/s0196-0644(88)80404-9
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  A review of all railroad-related deaths and significant injuries that occurred in a medium-sized metropolitan area from January 1, 1979, to June 30, 1986, was conducted. Autopsy reports were obtained for each fatality, and pre-hospital data were retrieved for all railroad-related injuries resulting in emergency medical services dispatch. There were ten fatalities (24%) and 31 survivors. The average age was 31.2 years (range, 1 to 67). Thirty-seven (90%) were men. Eleven persons (27%) were intoxicated (average blood alcohol of 279 mg/dL; range, 140 to 460). Of the 30 survivors transported, hospital records were available for 24. Thirteen were hospitalized and ten underwent surgery. Six major amputations occurred among survivors. Six patients had an Injury Severity Score of more than 15. Three mechanisms of injury occurred: falls on or from a train (56%); pedestrians hit by a train (41%), which accounted for all fatalities; and a train-automobile accident. This is the first comprehensive review of all significant railroad-related injuries in a metropolitan area.
• Meislin, H. W., Valenzuela, T. D., Spaite, D. W., Smith, R., Nelson, A., Meislin, H. W., & Criss, E. A. (1988). A new model for providing prehospital medical care in large stadiums.. Annals of emergency medicine, 17(8), 825-8. doi:10.1016/s0196-0644(88)80563-8
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  To determine proper priorities for the provision of health care in large stadiums, we studied the medical incident patterns occurring in a major college facility and combined this with previously reported information from four other large stadiums. Medical incidents were an uncommon occurrence (1.20 to 5.23 per 10,000 people) with true medical emergencies being even more unusual (0.09 to 0.31 per 10,000 people). Cardiac arrest was rare (0.01 to 0.04 events per 10,000 people). However, the rates of successful resuscitation in three studies were 85% or higher. The previous studies were descriptive in nature and failed to provide specific recommendations for medical aid system configuration or response times. A model is proposed to provide rapid response of advanced life support care to victims of cardiac arrest. We believe that the use of this model in large stadiums throughout the United States could save as many as 100 lives during each football season.
• Spaite, D. W., Smith, R., Sanders, A. B., & Criss, E. A. (1988). Allocation of time in three academic specialties.. The Journal of emergency medicine, 6(5), 435-7. doi:10.1016/0736-4679(88)90025-x
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  A survey was done to: 1) characterize the allocation and distribution of time by tenure track emergency physicians, and 2) compare the time distribution of emergency physicians to two other academic disciplines. All emergency medicine residency programs were surveyed by telephone to determine if faculty were eligible for tenure and if tenure was available, how many hours per week were spent on clinical duties, research, and administrative tasks. Similar information was compiled from cardiology and orthopedic surgery faculty at the same universities. Data from the survey revealed that a tenure track assistant professor spends 23 hours (46%) working clinical shifts in the emergency department; 11 hours (20%) doing research and 18 hours (34%) in administrative tasks. In contrast, cardiologists spend significantly more time in clinical duties (32 hours) and research (18 hours). However, cardiologists spend significantly less time in administrative duties (10 hours). Data for orthopedic surgeons show a similar pattern. Distributions within each academic discipline were also analyzed and a significant difference in research time was found between four tenure track emergency medicine programs and the other eighteen. Data from this survey may help academic emergency physicians evaluate how they are allocating their time in comparison to other busy clinical specialties.
• Sullivan, J. B., Spaite, D. W., & Dart, R. C. (1988). Skin testing in cases of possible crotalid envenomation.. Annals of emergency medicine, 17(1), 105-6. doi:10.1016/s0196-0644(88)80535-3
• Spaite, D. W., & Smith, R. A. (1987). Psychiatric presentation of medical illness.. The Journal of emergency medicine, 5(5), 367-73. doi:10.1016/0736-4679(87)90140-5
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  A 37-year-old woman was seen in the emergency department for symptoms of depression. A careful mental status examination resulted in the discovery of an organic basis for the "psychiatric" presentation. As with any patient demonstrating behavioral abnormalities, this case illustrates the importance of an adequate history, physical, and mental status evaluation in ruling out organic etiology prior to labeling a patient's complaints as functional. Medical illnesses that can present as apparent psychiatric disease and the clinical clues that lead to the diagnosis of such cases are discussed.

Proceedings Publications

• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Burgett, K., Seiver, A., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2024, January).

  Prehospital Nasal Capnography and Level of Consciousness in Major TBI: Association Between End-Tidal CO2 and Glasgow Coma Scale
  

  . In Prehospital Emergency Care.
• Rice, A., Spaite, D. W., Munn, R., Hannan, P., & Gaither, J. B. (2024, January). A liberal shocking strategy distorts Utstein survival calculation for out of hospital cardiac arrests: Knotts MC, Gaither JB, Hannan PL, Hollen A, Munn R, Spaite DW, Johnson H, Keeley B, Twilling S, Rice AD.   . In Prehospital Emergency Care.
• Wise, J. N., Rice, A., Lara, J. N., Munn, R., Knotts, M. R., Hannan, P., Spaite, D. W., & Gaither, J. B. (2024, January).

  Young Adult Willingness to use Automated Defibrillators and Perspectives on Early Bystander Defibrillation

  . In Prehospital Emergency Care.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Burgett, K., Seiver, A., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2023, November). End-Tidal CO2 and Glasgow Coma Scale in Non-Intubated Traumatic Brain Injury: Evaluation of Prehospital Nasal Capnography and Level of Consciousness
  . In Circulation, 147, Suppl.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Burgett, K., Seiver, A., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2023, September). End-Tidal CO2 and Glasgow Coma Scale in Non-Intubated Traumatic Brain Injury: Evaluation of Prehospital Nasal Capnography and Level of Consciousness
  . In Resuscitation.
• Gaither, J. B., Rice, A., Hannan, P., Munn, R., Dolana, B., Doty, B., Hollen, A., Knotts, M., Stevens, B., McDonough, S., French, R. N., Beskind, D. L., & Spaite, D. W. (2023, Jan). Automation of Out-Of-Hospital Cardiac Arrest Case Review improves EMS provider Performance on Benchmarks. In Prehospital Emergency Care, 27, S1-S96.
• Rice, A., Adrienne, H., Munn, R., Hannan, P., Mary, K., Beskind, D. L., French, R. N., Spaite, D. W., & Gaither, J. B. (2023, Jan).

  Improved time to turn around quality improvement feedback to providers using novel integrated quality improvement and feedback system

  . In Prehospital Emergency Care, 27, S74-75.
• Rice, A., Hu, C., Bobrow, B. J., Gaither, J. B., Bradley, G. H., Keim, S. M., Howard, J. T., & Spaite, D. W. (2023, Jan). New normal: the association between prehospital “near hypotension” and trauma center hypotension in traumatic brain injury.. In Prehospital Emergency Care, 27, S1-S96.
• Rice, A., Hu, C., Robyn, M., Lyra, C., Bruce, B., Josh, L., AnnMarie, S., Gaither, J. B., Gail, B., Keim, S. M., & Spaite, D. W. (2023, Jan).

  Patient bodyweight association with CPR quality and outcome

  . In Prehospital Emergency Care, 27, S97-S105.
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  1.     Rice AD, Hu C, McDannold R, Clark L, Barnhart BJ, Lampe J, Silver A, Gaither JB, Bradley G, Keim SM, Spaite DW. P
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Rice, A., Chikani, V., Denninghoff, K. R., Bradley, G., Howard, J. T., & Keim, S. M. (2023, Jan). The Risk of Arriving With Hypoxia at the Trauma Center Among Major TBI Patients Who Were Never Hypoxic in the Field: Support for “Hyper-oxic” Prehospital Treatment?. In Prehospital Emergency Care, 27, S1-S96.
• Wang, H., Hu, C., Barnhart, B. J., Jansen, J., & Spaite, D. W. (2023, Jan). Long-Term Trajectory of Neurologic Outcome after Severe Traumatic Brain Injury. In Prehospital Emergency Care, 27, S1-S96.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Adam, S., Helfenbein, E., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2022, Nov). Nasal Sensor Capnographic Differences in Major Traumatic Brain Injury Patients Receiving Non-Rebreather Mask Versus Nasal Cannula Oxygen Delivery. In Circulation, 146, Abs 167.
• Gould, J., Lampe, J., Barnhart, B., Spaite, D., & Pandit, S. (2022, Aug). Circadian Pattern of Shockable Rhythms in Out-of-Hospital Cardiac Arrest in Arizona. In Resuscitation, 175, S75.
• Hu, C., Rice, A., Denninghoff, K. R., Chikani, V., Barnhart, B. J., Keim, S. M., Bobrow, B. J., Spaite, D. W., & Gaither, J. B. (2022, January). Impact of Implementing the Prehospital Treatment Guidelines in Severe TBI Patients with Positive Pressure Ventilation: The EPIC Airway Sub-Analysis. In Prehospital Emergency Care, 26, 109 (Abs #5).
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  Gaither JB, Spaite DW, Bobrow BJ, Keim SM, Barnhart BJ, Chikani J, Denninghoff KR, Rice AD, Hu C: Impact of Implementing the Prehospital Treatment Guidelines in Severe TBI Patients with Positive Pressure Ventilation: The EPIC Airway Sub-Analysis. Prehospital Emerg Care 2022;26(1)Jan:109 (Abs #5)
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Adam, S., Gaither, J. B., Rice, A., Keim, S. M., Liu, C., & Hu, C. (2022, Aug). Discrepancies Between Non-Invasive Blood Pressure Monitor Data and EMS Provider Documentation: Are We Missing Hypotension?. In European Resuscitation Congress, 175, S55.
• Spaite, D. W., Howard, J. T., Keim, S. M., Bradley, G., Chikani, V., Gaither, J. B., Barnhart, B. J., Bobrow, B. J., Hu, C., & Rice, A. (2022, Jan). In-Field and Early Hospital Hypotension in Major Traumatic Brain Injury: Correlations and Effects on Outcome. In Prehospital Emergency Care, 26, 110 (Abs #6).
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  Rice AD, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Chikani V, Bradley GH, Keim SM, Howard JT, Spaite DW. In-Field and Early Hospital Hypotension in Major Traumatic Brain Injury: Correlations and Effects on Outcome. Prehospital Emerg Care 2022;26(1)Jan:110 (Abs #6)
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Rice, A., Chikani, V., Denninghoff, K. R., Bradley, G., Howard, J. T., & Keim, S. M. (2022, Jan). Hyperoxia and Outcome Before and After Implementation of the Prehospital Traumatic Brain Injury Guidelines. In Prehospital Emergency Care, 26, 111-112 (Abs #13).
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Rice AD, Chikani V, Denninghoff KR, Bradley GH, Howard JT, Keim SM: Hyperoxia and Outcome Before and After Implementation of the Prehospital Traumatic Brain Injury Guidelines. Prehospital Emerg Care 2022;26(1)Jan:111-112 (Abs #13)
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Rice, A., Chikani, V., Denninghoff, K. R., Bradley, G., Howard, J. T., & Keim, S. M. (2022, Nov). Hypoxia on Arrival at the Hospital Among Major Traumatic Brain Injury Patients Who Were Non-Hypoxic in the Field: Support for “Hyper-oxic” Prehospital Treatment?. In Circulation, 146, Abs 168.
• Wang, H., Hu, C., Barnhart, B. J., Jansen, J., & Spaite, D. W. (2022, Nov). Long-Term Trajectory of Neurologic Outcome After Severe Traumatic Brain Injury
  . In Circulation, 146, Abs 226.
• Wohlford, L., Barnhart, B. J., Spaite, D. W., Gaither, J. B., Rice, A., Bradley, G., Keim, S. M., & Hu, C. (2022, Jan). Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest. In Prehospital Emergency Care, 26, 155.
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  Wohlford L, Barnhart BJ, Spaite DW, Gaither JB, Rice AD, Bradley GH, Keim SM, Hu C: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2022;26(1)Jan:155 (Abs #178)
• Wohlford, L., Barnhart, B. J., Spaite, D. W., Keim, S. M., Gaither, J. B., Rice, A., Hu, C., & Bradley, G. H. (2022, Jan). Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest. In Prehospital Emergency Care, 26, Abs #178.
• Barnhart, B. J., Hu, C., Bradley, G., Spaite, D. W., Helfenbein, E., Keim, S. M., Jorgenson, D., Rice, A., Babaeizadeh, S., Gaither, J. B., Babaeizadeh, S., Gaither, J. B., Jorgenson, D., Rice, A., Helfenbein, E., Keim, S. M., Bradley, G., Spaite, D. W., Barnhart, B. J., & Hu, C. (2021, Jan). Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. In Prehospital Emergency Care, 24.
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  Barnhart B, Spaite DW, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Presented to the Annual Scientific Assembly of the National Association of EMS Physicians, January 13-16, 2021.
• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaeizadeh, S., Jorgenson, D., Helfenbein, E., Barnhart, B. J., & Spaite, D. W. (2021, November). Enhanced Prehospital End-Tidal CO2 Monitor Data Analysis for Intubated Severe Traumatic Brain Injury: Striking Findings from the EPIC Study. In Circulation.
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  Spaite DW, Barnhart B, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Hu C. Enhanced Prehospital End-Tidal CO2 Monitor Data Analysis for Intubated Severe Traumatic Brain Injury: Striking Findings From the EPIC Study. Circulation, 144(Suppl_2), A13737-A13737. https://doi.org/doi:10.1161/circ.144.suppl_2.13737
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Bradley, G., Rice, A., Howard, J. T., & Keim, S. M. (2021, Jan). Effect of Implementing the Prehospital Traumatic Brain Injury Guidelines on Survival in Severe TBI Patients Transported by Air and Ground EMS. In Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Keim SM: Effect of Implementing the Prehospital Traumatic Brain Injury Guidelines on Survival in Severe TBI Patients Transported by Air and Ground EMS. Prehosp Emerg Care 2021;25(1)Jan: Abs 93.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Bradley, G., Rice, A., Howard, J. T., & Keim, S. M. (2021, Jan). Optimal Prehospital Blood Pressure in Major Traumatic Brain Injury: Prospective Model Validation Using the Post-Intervention Cohort of the EPIC Study. In Prehospital Emergency Care, 25, Abs 41.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Keim SM: Optimal Prehospital Blood Pressure in Major Traumatic Brain Injury: Prospective Model Validation Using the Post-Intervention Cohort of the EPIC Study. Prehosp Emerg Care 2021;25(1)Jan: Abs 45.
• Spaite, D. W., Keim, S. M., Wang, H., Hu, C., Howard, J. T., Bobrow, B. J., Chikani, V., Rice, A., Bradley, G., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Denninghoff, K. R., Gaither, J. B., Barnhart, B. J., Bradley, G., Chikani, V., Rice, A., Bobrow, B. J., , Howard, J. T., et al. (2021, Jan). Inability of Prehospital Glasgow Coma Scale to Accurately Classify Brain Injury Severity: Has it Doomed TBI Clinical Trials to Failure?. In Prehospital Emergency Care, 24.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Wang H, Keim SM: Inability of Prehospital Glasgow Coma Scale to Accurately Classify Brain Injury Severity: Has it Doomed TBI Clinical Trials to Failure? Presented to the Annual Scientific Assembly of the National Association of EMS Physicians, January 13-16, 2021.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2020, November). Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. In Resuscitation Science Symposium, American Heart Association Scientific Sessions.
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  Barnhart BJ, Spaite DW, Helfenbein E, Jorgenson D, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Resuscitation Science Symposium, American Heart Association Scientific Sessions. Circulation. November, 2020.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaieizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2020, Jan). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-tidal CO2 and Level of Consciousness. In National Association of EMS Physicians Annual Meeting.
• Gaither, J. B., Gaither, J. B., Jado, I., Jado, I., Bradley, B., Bradley, B., Duncan, M., Duncan, M., Draper, S., Draper, S., Pike, R., Pike, R., Clark, J., Clark, J., Duran, N. S., Duran, N. S., Tolson, J. P., Tolson, J. P., Rice, A., , Rice, A., et al. (2020, Jan). In-Station Medication Systems Increase Administration of Controlled Substances During Advanced Life Support (ALS) Transports. In Annual Meeting of the National Association of EMS Physicians.
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  Gaither JB, Jado I, Bradley B, Duncan M, Draper S, Pike R, Clark J, Duran NS, Tolson JP, Rice AD, Spaite DW. In-Station Medication Systems Increase Administration of Controlled Substances During Advanced Life Support (ALS) Transports. Presented at the Annual Meeting of the National Association of EMS Physicians, January 9-11, 2020, San Diego, California.
• Keim, S. M., Rice, A., Denninghoff, K. R., Bradley, G., Mullins, T., Chikani, V., Gaither, J. B., Barnhart, B. J., Bobrow, B. J., Hu, C., & Spaite, D. W. (2020, November). Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. In Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Chikani V, Mullins T, Bradley G, Denninghoff KR, Rice AD, Keim SM: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Circulation, 2020. 142(Suppl_4): p. A362-A362.
• McDannold, R., Hu, C., Spaite, D. W., Silver, A. E., Mullins, M., Mullins, T., Chikani, V., Bradley, G., Gaither, J. B., Rice, A., Bobrow, B. J., Glenn, M., Keim, S. M., & Barnhart, B. J. (2020, Nov). Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests. In Resuscitation Science Symposium, American Heart Association Scientific Sessions.
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2020, November). Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. In Resuscitation Science Symposium, American Heart Association.
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  Spaite DW, Barnhart BJ, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension? Presented at the Resuscitation Science Symposium, American Heart Association. November 14-16, 2020.
• Spaite, D. W., Bobrow, B. J., Gaither, J. B., Barnhart, B. J., Keim, S. M., Chikani, V., Denninghoff, K. R., Mullins, T., Adelson, P. D., Rice, A., Viscusi, C. D., & Hu, C. (2020, Jan). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: Results of the EPIC4Kids Study. In Annual Meeting of the National Association of EMS Physicians.
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  Spaite DW, Bobrow BJ, Gaither JB, Barnhart BJ, Keim SM, Chikani V, Denninghoff K, Mullins T, Adelson PD, Rice AD, Viscusi C, Hu C: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: Results of the EPIC4Kids Study. Presented at the Annual Meeting of the National Association of EMS Physicians, January 7-11, 2020, San Diego, California.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Chikani, V., Mullins, T., Bradley, G., Denninghoff, K. R., Rice, A., & Keim, S. M. (2020, November). Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. In Resuscitation Science Symposium, American Heart Association.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Chikani V, Mullins T, Bradley G, Denninghoff KR, Rice AD, Keim SM: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Presented at the Resuscitation Science Symposium, American Heart Association. November 14-16, 2020.
• Spaite, D. W., Spaite, D. W., Bobrow, B. J., Bobrow, B. J., Gaither, J. B., Gaither, J. B., Barnhart, B. J., Barnhart, B. J., Keim, S. M., Keim, S. M., Chikani, V., Chikani, V., Denninghoff, K. R., Denninghoff, K. R., Mullins, T., Mullins, T., Adelson, P. D., Adelson, P. D., Rice, A., , Rice, A., et al. (2020, Jan). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: Results of the EPIC4Kids Study. In Annual Meeting of the National Association of EMS Physicians.
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  Spaite DW, Bobrow BJ, Gaither JB, Barnhart BJ, Keim SM, Chikani V, Denninghoff K, Mullins T, Adelson PD, Rice AD, Viscusi C, Hu C: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: Results of the EPIC4Kids Study. Presented at the Annual Meeting of the National Association of EMS Physicians, January 7-11, 2020, San Diego, California.
• Spaite, D. W., Spaite, D. W., Spaite, D. W., Barnhart, B. J., Barnhart, B. J., Barnhart, B. J., Helfenbein, E., Helfenbein, E., Helfenbein, E., Jorgenson, D., Jorgenson, D., Jorgenson, D., Babaieizadeh, S., Babaieizadeh, S., Babaieizadeh, S., Gaither, J. B., Gaither, J. B., Gaither, J. B., Rice, A., , Rice, A., et al. (2020, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring In Non-Intubated Major Traumatic Brain Injury Patients. In Annual Meeting of the National Association of EMS Physicians.
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  Spaite DW, Barnhart BJ, Helfenbein E, Jorgenson D, Babaieizadeh S, Gaither JB, Rice A, Keim SM, Hu C: End-Tidal CO2. Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring In Non-Intubated Major Traumatic Brain Injury Patients. Presented at the Annual Meeting of the National Association of EMS Physicians, January 7-11, 2020, San Diego, California
• Barnhardt, B. J., Spaite, D. W., Helfenbein, E., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Gaither, J. B., Rice, A., Keim, S. M., & Perez, O. (2019, Jan). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. In NAEMSP National Scientific Assembly.
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  Barnhart BJ, Spaite DW, Helfenbein E, Babaieizadeh S, Jorgenson D, Hu C, Gaither JB, Rice A, Keim SM, Perez O: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask.
• Barnhardt, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D. B., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2019, Fall). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between Ent-Tidal CO2 and Level of Consciousness. In Annual Meeting of the American Heart Association, Resuscitation Science Symposium.
• Enriquez, N. A., Enriquez, N. A., Janajreh, Y. M., Janajreh, Y. M., Tolson, J. P., Tolson, J. P., Mhayamaguru, K., Mhayamaguru, K., Rice, A., Rice, A., Smith, J., Smith, J., Spaite, D. W., Spaite, D. W., Draper, S., Draper, S., Duncan, M., Duncan, M., Gaither, J. B., & Gaither, J. B. (2019, Jan). Case Series Illustrating Adverse Reactions to Prehospital Administration of Low Dose Ketamine for Pain Control. In NAEMSP National Scientific Assembly.
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  Enriquez NA, Janajreh YM, Tolson JP, Mhayamaguru KM, Rice AD, Smith JJ, Spaite DW, Draper S, Duncan D, Gaither JB. Case Series Illustrating Adverse Reactions to Prehospital Administration of Low Dose Ketamine for Pain Control. Prehospital Emerg Care 2019
• Gaither, J. B., M, U., V, C., R, B., J, D. J., C, K., Rice, A., Denninghoff, K. R., Bobrow, B. J., Spaite, D. W., & Woolridge, D. P. (2019, May). Use of Supplemental Fields to Identify Additional Cases of Potential Abusive Head Trauma. In 22nd Annual Meeting of the Western Society for Academic Emergency Medicine.
• Maher, S., Rice, A. D., Gaither, J. B., Hu, C., Mullins, M., Spaite, D. W., & Bobrow, B. J. (2019, November). Cardiopulmonary Resuscitation Prior to Arrival of Emergency Medical Services in Arizona Extended Care Facilities. In Resuscitation Science Symposium, American Heart Association.
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  Maher SA, Rice AD, Gaither JB, Hu C, Mullins M, Spaite DW, Bobrow BJ: Cardiopulmonary Resuscitation Prior to Arrival of Emergency Medical Services in Arizona Extended Care Facilities. Presented at the Resuscitation Science Symposium, American Heart Association. Philadelphia, Pennsylvania; November 16-17, 2019.
• Perez, O., Spaite, D. W., Helfenbein, E., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Gaither, J. B., Rice, A., Keim, S. M., & Barnhardt, B. J. (2018, Aug). Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. In NAEMSP National Scientific Assembly.
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  Perez O, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson D, Hu C, Gaither JB, Rice A, Keim SM, Barnhart BJ: Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emerg Care 2019
• Perez, O., Spaite, D. W., Helfenbein, E., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Gaither, J. B., Rice, A., Keim, S. M., & Barnhardt, B. J. (2019, Jan). Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. In NAEMSP National Scientific Assembly.
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  Perez O, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson D, Hu C, Gaither JB, Rice A, Keim SM, Barnhart BJ: Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emerg Care 2019
• Spaite, D. W., Barnhardt, B. J., Helfenbein, E., Jorgenson, D. B., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2019, Fall). Prehospital Use of Nasal Cannual End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In Annual Meeting of the American Heart Association, Resuscitation Science Symposium.
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  Spaite DW, Barnhart BJ, Helfenbein E, Jorgenson D, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Hu C: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Presented at the Resuscitation Science Symposium, American Heart Association. Philadelphia, Pennsylvania; November 16-17, 2019.
• Spaite, D. W., Bobrow, B. J., Gaither, J. B., Keim, S. M., Barnhart, B. J., V, C., Denninghoff, K. R., T, M., D, A., Rice, A., Viscusi, C. D., & Hu, C. (2019, Nov). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: EPIC4Kids Study. In Annual Meeting of the American Heart Association, Resuscitation Science Symposium.
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  Spaite DW, Bobrow BJ, Gaither JB, Keim SM, Barnhart BJ, Chikani V, Denninghoff K, Mullins T, Adelson D, Rice AD, Viscusi C, Hu C: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: The EPIC4Kids Study. Presented at the Resuscitation Science Symposium, American Heart Association. Philadelphia, Pennsylvania; November 16-17, 2019.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhardt, B. J., Chikani, V., Gaither, J. B., Denninghoff, K. R., Rice, A., & Keim, S. M. (2019, Jan). Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. In NAEMSP National Scientific Assembly.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Chikani V, Gaither JB, Denninghoff K, Rice A, Keim SM: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. Prehospital Emerg Care 2019
• Barnhardt, B. J., Spaite, D. W., Helfenbein, E., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Gaither, J. B., Rice, A., Keim, S. M., & Perez, O. (2018, Nov). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. In Resuscitation Science Symposium (ReSS) of the American Heart Association (AHA).
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  Barnhart B, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson DB, Hu C, Gaither JB, Rice AD, Keim SM, Perez O: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Circulation 2018
• Beger, S., Berger, S., Smith, G., Smith, G., Chikani, V., Chikani, V., Spaite, D. W., Spaite, D. W., Keim, S. M., Keim, S. M., Mullins, T., Mullins, T., George, T., George, T., Bobrow, B. J., & Bobrow, B. J. (2018, Jan). Statewide Trends in Out-of-Hospital Cardiac Arrest Related to Drug Overdose. In Annual Meeting of the National Association of EMS Physicians.
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  Beger S, Smith G, Chikani V, Spaite D, Keim S, Mullins T, George T, Bobrow B: Statewide Trends in Out-of-Hospital Cardiac Arrest Related to Drug Overdose. Presented at the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, California.
• Bobrow, B. J., Panczyk, M., Blust, R., Brazil, P., George, T., Chikani, V., Hu, C., & Spaite, D. W. (2018, Jan). Death by Suicide: The EMS Profession Compared to the General Public. In NAEMSP National Scientific Assembly.
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  Bobrow BJ, Panczyk M, Blust R, Brazil P, George T, Chikani V, Hu C, Spaite DW: Death by Suicide: The EMS Profession Compared to the General Public. Presented to the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, California.
• Gaither, J. B., Mhayamaguru, K., Rice, A., Waters, K. E., Smith, J. J., Beskind, D. L., & Spaite, D. W. (2018, Jan). Use of Distance Education Tools to Improve the Rural EMS Experience for EMS Fellows. In NAEMSP National Scientific Assembly.
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  Gaither JG, Mhayamaguru KM, Rice A, Waters KE, Smith JJ, Beskind D, Spaite DW. Use of Distance Education Tools to Improve the Rural EMS Experience for EMS Fellows. Presented at the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, California.
• Gaither, J. B., Rice, A., Hu, C., McDannold, R., Mullins, M., Spaite, D. W., Vadeboncoeur, T. F., George, T., Mullins, T., & Bobrow, B. J. (2018, Jan). Comparison of Manual Vs. Mechanical Chest Compression Quality During Prehospital Cardiac Resuscitation. In NAEMSP National Scientific Assembly.
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  Gaither J, Rice A, Hu C, McDannold R, Mullins M, Spaite D, Vadeboncoeur T, George T, Mullins T, Bobrow B: Comparison of Manual Vs. Mechanical Chest Compression Quality During Prehospital Cardiac Resuscitation. Presented at the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, California.
• Keim, S. M., Rice, A. D., Denninghoff, K. R., Gaither, J. B., Chikani, V., Barnhart, B., Bobrow, B. J., Hu, C., & Spaite, D. W. (2018, Nov). Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Spaite DW, Hu C, Bobrow BJ, Barnhart B, Chikani V, Gaither JB, Denninghoff KR, Rice AD, Keim SM: Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 10-11, 2018, Chicago, Illinois.
• Perez, O., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Jorgenson, D., Hu, C., Chikani, V., Gaither, J. B., Keim, S. M., Sherril, D., & Spaite, D. W. (2018, Jan). Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. In NAEMSP National Scientific Assembly.
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  Perez O, Helfenbein E, Barnhart BJ, Babaeizadeh S, Jorgenson D, Hu C, Chikani V, Gaither J, Keim S, Sherrill D, Spaite D: Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emerg Care 2018;22(1):123-124.
• Perez, O., Spaite, D. W., Helfenbein, E., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Gaither, J. B., Rice, A., Keim, S. M., & Barnhardt, B. J. (2018, Nov). Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. In Resuscitation Science Symposium (ReSS) of the American Heart Association (AHA).
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  Perez O, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson DB, Hu C, Gaither JB, Rice AD, Keim SM, Barnhart B: Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation 2018
• Rice, A., Gaither, J. B., Spaite, D. W., Chikani, V., Wentworth, S., Vadeboncoeur, T. F., George, T., Mullins, T., & Bobrow, B. J. (2018, Jan). Rearrest Incidence and Post-ROSC Rhythms after Prehospital Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest. In NAEMSP National Scientific Assembly.
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  Rice A, Gaither J, Spaite D, Chikani V, Wentworth S, Vadeboncoeur T, George T, Mullins T, Bobrow B: Rearrest Incidence and Post-ROSC Rhythms after Prehospital Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest. Presented to the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, California.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhardt, B. J., Chikani, V., Gaither, J. B., Denninghoff, K. R., Rice, A., & Keim, S. M. (2018, Nov). Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. In Resuscitation Science Symposium (ReSS) of the American Heart Association (AHA).
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  Spaite DW, Hu C, Bobrow BJ, Barnhart B, Chikani V, Gaither JB, Denninghoff KR, Rice AD, Keim SM: Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. Circulation 2018
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Viscusi, C. D., Sherrill, D. L., & Keim, S. M. (2018, Jan). Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. In NAEMSP National Scientific Assembly.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Viscusi C, Sherrill D, Keim SM: Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Presented to the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, California.
• Spaite, D. W., Keim, S. M., Hu, C., Rice, A., Bobrow, B. J., Denninghoff, K. R., Barnhardt, B. J., Gaither, J. B., Chikani, V., Chikani, V., Barnhardt, B. J., Gaither, J. B., Denninghoff, K. R., Bobrow, B. J., Hu, C., Rice, A., Keim, S. M., & Spaite, D. W. (2018, Nov). Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. In Resuscitation Science Symposium (ReSS) of the American Heart Association (AHA).
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  Spaite DW, Hu C, Bobrow BJ, Barnhart B, Chikani V, Gaither JB, Denninghoff KR, Rice AD, Keim SM: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. Circulation 2018
• Sutter, J. H., Spaite, D. W., Beger, S., Hu, C., Spaite, D. W., Silver, A., McDannold, R., Mullins, M., Vadeboncoeur, T., & Bobrow, B. J. (2018, Nov). Associations of Chest Compression Release Velocity and Age, Weight, and Gender During Cardiac Resuscitation. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Sutter JH, Beger S, Hu C, Spaite DW, Silver A, McDannold R, Mullins M, Vadeboncoeur T, Bobrow BJ: Associations of Chest Compression Release Velocity and Age, Weight, and Gender During Cardiac Resuscitation. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 10-12, 2018, Chicago, Illinois.
• Barnhardt, B. J., Helfenbein, E., Perez, O., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Chikani, V., Gaither, J. B., Sherill, D., Keim, S. M., & Spaite, D. W. (2017, Nov). Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Barnhart BJ, Helfenbein E, Perez O, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Sherrill D, Keim SM, Spaite DW: Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 11-13, 2017, Anaheim, California.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherrill, D. L., Rice, A., Bobrow, B. J., Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., , Hu, C., et al. (2017, September). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major TBI Patients. In Mediterranean Emergency Medicine Congress.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Rice AD, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major TBI Patients. Presented to the Mediterranean Emergency Medicine Congress, September 6-10, 2017, Lisbon, Portugal.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherrill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, January). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emerg Care 2017:21(1):95.
• Beger, S., Sutter, J., Hu, C., Spaite, D. W., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2017, Jan). Decline in Chest Compression Velocity Over Time is Related to Out-Of-Hospital Cardiac Arrest Outcome. In Annual Meeting of the National Association of Emergency Physicians, 21, 100.
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  Beger S, Sutter J, Hu C, Spaite D, McDannold R, Mullins M, Vadeboncoeur TF, Bobrow BJ: Decline in Chest Compression Velocity Over Time is Related to Out-Of-Hospital Cardiac Arrest Outcome. Prehospital Emerg Care 2017:21(1):100.
• Beger, S., Sutter, J., Hu, C., Spaite, D. W., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2017, Jan). Decline in Chest Compression Velocity Over Time is Related to Out-Of-Hospital Cardiac Arrest Outcome. In National Association of Emergency Physicians Annual Meeting.
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  Beger S, Sutter J, Hu C, Spaite D, McDannold R, Mullins M: Decline in Chest Compression Velocity Over Time is Related to Out-Of-Hospital Cardiac Arrest Outcome. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• Gaither, J. B., Rice, A., Hu, C., Silver, A., McDannold, R., Mullins, M., Spaite, D. W., Vadeboncoeur, T. F., George, T. A., Mulllins, T., & Bobrow, B. J. (2017, Nov). Comparison of Manual vs. Mechanical Chest Compression Quality during Prehospital Cardiac Resuscitation. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Gaither JB, Rice AD, Hu C, Silver A, McDannold R, Mullins M, Spaite DW, Vadeboncoeur TF, George TA, Mullins T, Bobrow BJ: Comparison of Manual vs. Mechanical Chest Compression Quality during Prehospital Cardiac Resuscitation. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 11-13, 2017, Anaheim, California.
• Hu, C., Spaite, D. W., Silver, A., Gaither, J. B., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2017, Jan). Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. In Annual Meeting of the National Association of EMS Physicians, 21, 92.
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  Hu C, Spaite DW, Silver A, Gaither J, McDannold R, Mullins M, Vadeboncoeur T, Bobrow B. Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Prehospital Emerg Care 2017:21(1):92
• Hu, C., Spaite, D. W., Silver, A., Gaither, J. B., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2017, Jan). Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. In National Association of EMS Physicians Annual Meeting.
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  Hu C, Spaite DW, Silver A, Gaither J, McDannold R, Mullins M, Vadeboncoeur T, Bobrow B. Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• Langlais, B., Sutter, J., Bohm, K., Panczyk, M., Hu, C., Spaite, D. W., & Bobrow, B. J. (2017, Jan). Telecommunicator Breathing Assessment Techniques in Out-Of-Hospital Cardiac Arrest. In Annual Meeting of the National Association of EMS Physicians, 21, 124-125.
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  Langlais B, Sutter J, Bohm K, Panczyk M, Hu C, Spaite DW, Bobrow BJ: Telecommunicator Breathing Assessment Techniques in Out-Of-Hospital Cardiac Arrest. Prehospital Emerg Care 2017:21(1):124-125.
• Langlais, B., Sutter, J., Bohm, K., Panczyk, M., Hu, C., Spaite, D. W., & Bobrow, B. J. (2017, Jan). Telecommunicator Breathing Assessment Techniques in Out-Of-Hospital Cardiac Arrest. In National Association of EMS Physicians Annual Meeting.
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  Langlais B, Sutter J, Bohm K, Panczyk M, Hu C, Spaite DW, Bobrow BJ: Telecommunicator Breathing Assessment Techniques in Out-Of-Hospital Cardiac Arrest. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• Perez, O., Helfenbein, E., Barnhardt, B. J., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Chikani, V., Gaither, J. B., Keim, S. M., Sherill, D., & Spaite, D. W. (2017, Nov). Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Perez O, Helfenbein E, Barnhart BJ, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Keim SM, Sherrill D, Spaite DW: Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 11-13, 2017, Anaheim, California.
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherrill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, January). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In Annual Meeting of the National Association of EMS Physicians.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Rice AD, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emerg Care 2017:21(1):97.
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherrill, D. L., Rice, A. D., & Bobrow, B. J. (2017, Jan). Prehospital Use of Nasal Cannula End-Tidal Co2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In National Association of EMS Physicians Annual Meeting.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B. J., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Mullins, T., Sherrill, D., & Keim, S. M. (2017, Nov). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Mullins T, Sherrill D, Keim SM: Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 11-13, 2017, Anaheim, California.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B. J., Adelson, P. D., Rice, A. D., Grady, K., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. (2017, January). Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians, 21, 91.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart BJ, Adelson PD, Rice AD, Grady K, Denninghoff KR, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2017:21(1):91.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Viscusi, C. D., Mullins, T., Sherrill, D. L., & Keim, S. M. (2017, November). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Viscusi C, Mullins T, Sherrill D, Keim SM: Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Presented to American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions, November, 2017, Anaheim, CA.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Rice, A. D., Grady, K., & Keim, S. M. (2017, Sept). Effect of Prehospital Hypoxia “Depth-Duration Dose” on Mortality in Major Traumatic Brain Injury. In Mediterranean Emergency Medicine Congress.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart BJ, Adelson PD, Rice AD, Grady K, Keim SM: Effect of Prehospital Hypoxia “Depth-Duration Dose” on Mortality in Major Traumatic Brain Injury. Presented to the Mediterranean Emergency Medicine Congress, September 6-10, 2017, Lisbon, Portugal.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Rice, A. D., Grady, K., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. L. (2017, Jan). Evaluation Of Prehospital Hypoxia "Depth-Duration Dose'' and Mortality in Major Traumatic Brain Injury. In National Association of EMS Physicians Annual Meeting.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart BJ, Adelson PD, Rice AD, Grady K, Denninghoff KR, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, November). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions, 133, A15795.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2016;133:A15795
• Beger, S., Sutter, J., Hu, C., Spaite, D. W., Silver, A., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2016, November). Decline in Chest Compression Release Velocity over Time is Associated with Out-of-Hospital Cardiac Arrest Outcomes. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions.
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  Beger S, Sutter J, Hu C, Spaite DW, Silver A, McDannold R, Mullins M, Vadeboncoeur TF, Bobrow BJ. Decline in Chest Compression Release Velocity over Time is Associated with Out-of-Hospital Cardiac Arrest Outcomes. Circulation 2016;133
• Dameff, C. J., Tully, J., Panczyk, M., Kannan, V., Vadeboncoeur, T. F., Spaite, D. W., & Bobrow, B. J. (2016, January). 9-1-1 Caller descriptions of Abnormal Breathing During Out-of-Hospital Cardiac Arrest. In Annual Meeting of the National Association of EMS Physicians, 20, 147.
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  Dameff CJ, Tully J, Panczyk M, Kannan V, Vadeboncoeur T, Spaite DW, Bobrow BJ: 9-1-1 Caller descriptions of Abnormal Breathing During Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2016;20(1):147.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2016, January). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians, 20, 141.
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  Gaither JB, Chikani V, Spaite DW, Smith JJ, Curry M, Mhayamaguru M, Barnhart B, Adelson PD, Viscusi C, Denninghoff KR, Bobrow B: Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Prehospital Emerg Care 2016;20(1):141.
• Hu, C., Spaite, D. W., Silver, A., Gaither, J. B., McDannold, R., Mullins, M., Vadeboncoeur, T., & Bobrow, B. J. (2016, November). Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions, 133.
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  Hu C, Spaite D, Silver A, Gaither J, McDannold R, Mullins M, Vadeboncoeur T, Bobrow B. Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Circulation 2016;133
• Hu, C., Spaite, D. W., Vadeboncoeur, T. F., Hypes, C. D., Murphy, R. A., Silver, A., & Bobrow, B. J. (2016, January). ETC02 Alone is Inadequate to Verify CPR Quality. In Annual Meeting of the National Association of EMS Physicians.
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  Hu C, Spaite DW, Vadeboncoeur T, Hypes C, Murphy RA, Silver A, Bobrow BJ: ETC02 Alone is Inadequate to Verify CPR Quality. Prehospital Emerg Care 2016;20(1):141-142.
• Hu, C., Spaite, D. W., Vadeboncoeur, T., Hypes, C., Murphy, R., Silver, A., & Bobrow, B. J. (2016, January 14-16). ETCO2 Alone is Inadequate to Verify CPR Quality. In National Association of EMS Physicians Annual Meeting.
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  Hu C, Spaite DW, Vadeboncoeur T, Hypes C, Murphy R, Silver A, and Bobrow BJ. 2016. ETCO2 alone is inadequate to verify CPR quality. Prehospital Emerg Care, 2016;20(1):144-145.
• Irisawa, T., Vadeboncoeur, T. F., Hypes, C. D., McDannold, R., Mullins, M., Silver, A., Spaite, D. W., & Bobrow, B. J. (2016, January). Maintaining High Quality CPR With an Integrated Manual/Mechanical Resuscitation Protocol. In Annual Meeting of the National Association of EMS Physicians.
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  Irisawa T, Vadeboncoeur T, Hypes C, McDannold R, Mullins M, Silver A, Spaite DW, Bobrow BJ: Maintaining High Quality CPR With an Integrated Manual/Mechanical Resuscitation Protocol. Prehospital Emerg Care 2016;20(1):141-142.
• McDannold, R., Glenn, M., Tobin, J., Venuti, M., Silver, A., Spaite, D. W., & Bobrow, B. J. (2016, January). Prehospital Vital Sign Monitoring and Traumatic Brain Injury: What We Don’t See Could Kill You. In Annual Meeting of the National Association of EMS Physicians, 20, 172.
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  McDannold R, Glenn M, Tobin J, Venuti M, Silver A, Spaite D, Bobrow B: Prehospital Vital Sign Monitoring and Traumatic Brain Injury: What We Don’t See Could Kill You. Prehospital Emerg Care 2016;20(1):172.
• Nuno, T., Bobrow, B. J., Rogge-Miller, K. A., Panczyk, M., Esparza, M., Martinez, R. A., Mullins, T., & Spaite, D. W. (2016, January). Disparities in Utilization of 9-1-1 for Out-of-Hospital Cardiac Arrests Among Spanish Speaking Callers. In Annual Meeting of the National Association of EMS Physicians, 20, 146-147.
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  Nuno T, Bobrow BJ, Rogge-Miller KA, Panczyk M, Esparza M, Martinez R, Mullins T, Spaite DW: Disparities in Utilization of 9-1-1 for Out-of-Hospital Cardiac Arrests Among Spanish Speaking Callers. Prehospital Emerg Care 2016;20(1):146-147.
• Panczyk, M., Sutter, J., Langlais, B., Hu, C., Vadeboncoeur, T. F., Mullins, T., Spaite, D. W., & Bobrow, B. J. (2016, November). Telephone CPR is Independently Associated with an Increase in Initial Shockable Rhythms in Patients with Out-of-Hospital Cardiac Arrest. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions, 133.
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  Panczyk M, Sutter J, Langlais B, Hu C, Vadeboncoeur TF, Mullins T, Spaite DW, Bobrow BJ. Telephone CPR is Independently Associated with an Increase in Initial Shockable Rhythms in Patients with Out-of-Hospital Cardiac Arrest. Circulation 2016;133
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherril, D., & Bobrow, B. J. (2016, November). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions, 133, A13835.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Vatsal C, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation 2016;133:A13835
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. L. (2016, November). Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions, 133, A15910.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Adelson PD, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. Circulation 2016;A15910
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Viscusi, C. D., Mullins, T., Martinez, R., & Adelson, P. D. (2016, January). Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians, 20, 137.
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  Spaite DW, Hu Chengcheng, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, Gaither JB, Denninghoff KR, Viscusi C, Mullins T, Martinez R, Adelson PD. Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2016;20(1):137.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Denninghoff, K. R., & Stolz, U. (2016, January). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study. In Annual Meeting of the National Association of EMS Physicians, 20, 140-141.
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  Spaite DW, Hu C, Bobrow BJ, Sherrill D, Chikani V, Barnhart B, Gaither JB, Denninghoff KR, Adelson PD, Viscusi C, Mullins T, Stolz U. Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study. Prehospital Emerg Care 2016;20(1):140-141.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Denninghoff, K. R., & Stolz, U. (2016, January). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study.. In Annual Meeting of the National Association of EMS Physicians.
• Vadeboncoeur, T. F., Chikani, V., Spaite, D. W., Hu, C., Mullins, M., & Bobrow, B. J. (2016, November). Association between Coronary Angiography With or Without Percutaneous Coronary Intervention and Outcomes after Out-of-Hospital Cardiac Arrest. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions.
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  Vadeboncoeur TF, Chikani V, Spaite DW, Hu C, Mullins M, Bobrow BJ. Association between Coronary Angiography With or Without Percutaneous Coronary Intervention and Outcomes after Out-of-Hospital Cardiac Arrest. Circulation 2016;133
• Bobrow, B. J., Panczyk, M., Stolz, U., Vadeboncoeur, T. F., Sutter, J., Langlais, B., & Spaite, D. W. (2015, Jan). Statewide Implementation of a Standardized Pre-Arrival Telephone CPR Program is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest. In Prehospital Emergency Care, 19, 140-141.
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  Bobrow B, Panczyk M, Stolz U, Vadeboncoeur T, Sutter J, Langlais B, Spaite D: Statewide Implementation of a Standardized Pre-Arrival Telephone CPR Program is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2015;19(1):140-141.
• Bobrow, B. J., Spaite, D. W., Murphy, R. A., Silver, A., McDannold, R., Mullins, M., Stolz, U., & Kaufman, C. (2015, January). The Association Between ETC02 and Chest Compression Depth During Prehospital Resuscitation: ETCO2 Alone is Inadequate to Assess CPR Quality. In Annual Meeting of the National Association of EMS Physicians.
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  Bobrow B, Spaite D, Murphy RA, Silver A, McDannold R, Mullins M, Stolz U, Kaufman C. The Association Between ETC02 and Chest Compression Depth During Prehospital Resuscitation: ETCO2 Alone is Inadequate to Assess CPR Quality. Prehospital Emerg Care 2015;19(1):144.
• Gaither, J. B., Bradshaw, H. R., Smith, J. J., Waters, K. E., & Spaite, D. W. (2015, January). Development of a Novel Course to Integrate EMS Fellow, Emergency Medicine Resident, and Undergraduate Education in EMS Systems Organization and Deployment. In Annual Meeting of the National Association of EMS Physicians, 19, 340.
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  Gaither JB, Bradshaw HR, Smith JJ, Waters K, Spaite DW: Development of a Novel Course to Integrate EMS Fellow, Emergency Medicine Resident, and Undergraduate Education in EMS Systems Organization and Deployment. Prehospital Emerg Care 2015;19(2):340.
• Gaither, J. B., Chikani, V., Spaite, D. W., Stolz, U., Garrison, S., Smith, J., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2015, January). Association Between Initial Trauma Center Body Temperature and Mortality from Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians, 19, 165.
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  Gaither JB, Chikani V, Spaite DW, Stolz U, Garrison S, Smith J, Barnhart B, Adelson PD, Viscusi C, Denninghoff K, Bobrow BJ: Association Between Initial Trauma Center Body Temperature and Mortality from Major Traumatic Brain Injury. Prehospital Emerg Care 2015;19(1):165.
• Gaither, J. B., Gaither, J. B., Chikani, V., Chikani, V., Spaite, D. W., Spaite, D. W., Smith, J. J., Smith, J. J., Curry, M., Curry, M., Mhayamaguru, M., Mhayamaguru, M., Barnhart, B. J., Barnhart, B. J., Adelson, P. D., Adelson, P. D., Viscusi, C. D., Viscusi, C. D., Denninghoff, K. R., , Denninghoff, K. R., et al. (2015, November). Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. In Resuscitation Science Symposium of the American Heart Association, 132.
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  Gaither JB, Chikani V, Spaite DW, Smith JJ, Curry M, Mhayamaguru M, Barnhart B, Adelson PD, Viscusi C, Denninghoff KR, Bobrow B; Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. Circulation 2015;132:A.
• Gaither, J. B., Spaite, D. W., Bradshaw, H. R., Waters, K. E., Smith, J. J., Smith, J. J., Waters, K. E., Bradshaw, H. R., Spaite, D. W., Gaither, J. B., Gaither, J. B., Bradshaw, H. R., Smith, J. J., Waters, K. E., & Spaite, D. W. (2015, January). Development of a Novel Course to Integrate EMS Fellow, Emergency Medicine Resident, and Undergraduate Education in EMS Systems Organization and Deployment. In Annual Meeting of the National Association of EMS Physicians.
• Hu, C., Keim, S. M., Gaither, J. B., Rice, A., Bradley, G. H., McDannold, R., Spaite, D. W., Barnhart, B. J., & Wohlford, L. (2021, Sep). Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. In Prehospital Emergency Care.
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  Wohlford L, Barnhart B, Spaite DW, McDannold R, Bradley GH, Rice AD, Gaither JB, Keim SM, Hu C: Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. Prehospital Emergency Care, 25:1, 125-170, DOI: 10.1080/10903127.2020.1837312
• Hu, C., Spaite, D. W., Vadeboncoeur, T. F., Hypes, C. D., Murphy, R. A., Silver, A., & Bobrow, B. J. (2015, November). ETCO2 Alone is Inadequate to Verify CPR Quality. In Resuscitation Science Symposium of the American Heart Association, 132, A18435.
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  Hu C, Spaite D, Vadeboncoeur T, Hypes C, Murphy RA, Silver A, Bobrow B: ETCO2 alone is inadequate to verify CPR quality. Circulation 2015;132:A18435
• Hypes, C. D., Spaite, D. W., Vadeboncoeur, T. F., Murphy, R. A., Hu, C., McDannold, R., Silver, A., & Bobrow, B. J. (2015, November). Elevated PETCO2 During Cardiac Resuscitation Without Return of Spontaneous Circulation. In Resuscitation Science Symposium of the American Heart Association, 132, A19572.
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  Hypes C, Spaite D, Vadeboncoeur T, Murphy RA, Hu C, McDannold R, Silver A, Bobrow B: Elevated petco2 during cardiac resuscitation without return of spontaneous circulation. Circulation 2015;132:A19572
• Irisawa, T., Stolz, U., Spaite, D. W., Silver, A., Vadeboncoeur, T., & Bobrow, B. J. (2015, January). Chest Compression Release Velocity Declines over Time during CPR. In Annual Meeting of National Association of EMS Physicians, 19, 144-145.
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  Irisawa T, Stolz U, Spaite D, Silver A, Vadeboncoeur T, Bobrow B: Chest Compression Release Velocity Declines over Time during CPR. Prehospital Emerg Care 2015;19(1):144-145.
• Langlais, B., Panczyk, M., Irisawa, T., Ryoo, H. W., Jaber, J., Spaite, D. W., & Bobrow, B. J. (2015, January). Barriers to Effective Bystander-Initiated CPR in Out-of-Hospital Cardiac Arrest. In Annual Meeting of the National Association of EMS Physicians.
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  Langlais B, Panczyk M, Irisawa T, Ryoo HW, Jaber J, Spaite D, Bobrow B: Barriers to Effective Bystander-Initiated CPR in Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2015;19(1):170.
• Spaite, D. W. (2015, January). Controversies in the EMS Management of Traumatic Brain Injury. In National Association of EMS Physicians.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Martinez, R. A., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2015, November). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. In Resuscitation Science Symposium of the American Heart Association, 132, A14938..
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  Spaite DW, Hu Chengcheng, Bobrow BJ, Sherrill D, Chikani V, Barnhart B, Martinez R, Gaither JB, Denninghoff KR, Adelson PD, Viscusi C, Mullins T, Stolz U: Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. Circulation 2015;132:A14938.
• Stolz, U., Irisawa, T., Ryoo, H. W., Silver, A., McDannold, R., Jaber, J., Spaite, D. W., & Bobrow, B. J. (2015, January). Time in CPR is Significantly Related to CPR Quality and Survival. In Annual Meeting of the National Association of EMS Physicians.
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  Stolz U, Irisawa T, Ryoo HW, Silver A, McDannold R, Jaber J, Spaite D, Bobrow B: Time in CPR is Significantly Related to CPR Quality and Survival. Prehospital Emerg Care 2015;19(1):145
• Stolz, U., Spaite, D. W., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Humble, W. O., & Denninghoff, K. R. (2015, January). Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold?. In Annual Meeting of the National Association of EMS Physicians, 19, 143.
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  Stolz U, Spaite DW, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, Gaither JB, Adelson PD, Viscusi C, Mullins T, Humble W, Denninghoff KR: Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold? Prehospital Emerg Care 2015;19(1):143.
• Sutter, J., Langlais, B., Dameff, C., Tully, J., Panczyk, M., Chikani, V., Vadeboncoeur, T. F., Spaite, D. W., & Bobrow, B. J. (2015, November). Telecommunicator CPR intervention improves recognition of cardiac arrest and time to first chest compression. In American Heart Association (AHA) Resuscitation Science Symposium, 132, A12075.
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  Sutter J, Langlais B, Dameff C, Tully J, Panczyk M, Chikani V, Vadeboncoeur TF, Spaite DW, Bobrow BJ: Telecommunicator CPR intervention improves recognition of cardiac arrest and time to first chest compression. Circulation 2015:132:A12075

Presentations

• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Burgett, K., Seiver, A., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2024, January).

  Prehospital Nasal Capnography and Level of Consciousness in Major TBI: Association Between End-Tidal CO2 and Glasgow Coma Scale
  

  . Scientific Assembly National Association of EMS PhysiciansNational Association of EMS Physicians.
• Spaite, D. W. (2024, January).

  National EMS Airway Course

  . Scientific Assembly of the National Association of EMS Physicians. Austin, Texas: National Association of EMS Physicians.
• Wise, J. N., Rice, A., Lara, J. N., Munn, R., Knotts, M. R., Hannan, P., Spaite, D. W., & Gaither, J. B. (2024).

  Young Adult Willingness to use Automated Defibrillators and Perspectives on Early Bystander Defibrillation
  
  

  . Annual Scientific Assembly of the National Association of EMS Physicians. Austin, Texas: National Association of EMS Physicians.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Burgett, K., Seiver, A., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2023, November). End-Tidal CO2 and Glasgow Coma Scale in Non-Intubated Traumatic Brain Injury: Evaluation of Prehospital Nasal Capnography and Level of Consciousness
  . European Resuscitation Council Congress. Barcelona, Spain: European Resuscitation Council Congress.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Burgett, K., Seiver, A., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2023, November). End-Tidal CO2 and Glasgow Coma Scale in Non-Intubated Traumatic Brain Injury: Evaluation of Prehospital Nasal Capnography and Level of Consciousness
  . Resuscitation Science Symposium. Philadelphia, Pennsylvania: American Heart Association.
• Rice, A., Adrienne, H., Munn, R., Hannan, P., Mary, K., Beskind, D. L., French, R. N., Spaite, D. W., & Gaither, J. B. (2023, Jan).

  Improved time to turn around quality improvement feedback to providers using novel integrated quality improvement and feedback system

  . Scientific Assembly of the National Association of EMS Physicians. Tampa, Florida: National Association of EMS Physicians.
• Rice, A., Hu, C., Bobrow, B. J., Gaither, J. B., Bradley, G. H., Keim, S. M., Howard, J. T., & Spaite, D. W. (2023, Jan). New normal: the association between prehospital “near hypotension” and trauma center hypotension in traumatic brain injury
  . Annual Meeting of the National Association of EMS Physicians. Tampa, Florida: National Association of EMS Physicians.
• Rice, A., Hu, C., Robyn, M., Lyra, C., Bruce, B., Josh, L., AnnMarie, S., Gaither, J. B., Gail, B., Keim, S. M., & Spaite, D. W. (2023, Jan).

  Patient bodyweight association with CPR quality and outcome

  . Annual Scientific Assembly of the National Association of EMS Physicians. Tampa, Florida: National Association of EMS Physicians.
• Spaite, D. W. (2023, Jan). Too Much O2? Should We Limit Prehospital Oxygen Delivery in Non-hypoxic TBI Patients???. Scientific Assembly of the National Association of EMS Physicians. Tampa, Florida: National Association of EMS Physicians.
• Spaite, D. W. (2023, Jan). National EMS Airway Course. National Association of EMS Physicians Scientific Assembly. Tampa, Florida: National Association of EMS Physicians.
• Spaite, D. W. (2023, Nov). New and Surprising Findings from the EPIC Prehospital Traumatic Brain Injury Sub-studies. 50th Annual Colorado State EMS Conference. Keystone, Colorado: Colorado Chapter of the National Association of EMS Physicians.
• Spaite, D. W. (2023, Sept). New, Surprising, and Provocative Findings from the EPIC EMS Brain Injury Data: Implications for Military and Civilian Prehospital TBI Treatment. Command leadership and neuroscientists of the DOD’s Medical Development and Research CommandUS Department of Defense.
• Spaite, D. W., Gaither, J. B., Beskind, D. L., Rice, A., French, R. N., Hannan, P., McDonough, S., Munn, R., Dolana, B., Stevens, B., Doty, B., Knotts, M., Hollen, A., Hollen, A., Knotts, M., Doty, B., Stevens, B., Dolana, B., McDonough, S., , Munn, R., et al. (2023, Jan). Automation of Out-Of-Hospital Cardiac Arrest Case Review improves EMS provider Performance on Benchmarks. Scientific Assembly of the National Association of EMS Physicians. Tampa, Florida: National Association of EMS Physicians.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Rice, A., Chikani, V., Denninghoff, K. R., Bradley, G., Howard, J. T., & Keim, S. M. (2023, Jan). The Risk of Arriving With Hypoxia at the Trauma Center Among Major TBI Patients Who Were Never Hypoxic in the Field: Support for “Hyper-oxic” Prehospital Treatment?
  . Annual Scientific Assembly of the National Association of EMS Physicians. Tampa, Florida: National Association of EMS Physicians.
• Wang, H., Hu, C., Barnhart, B. J., Jansen, J., & Spaite, D. W. (2023, Jan). Long-Term Trajectory of Neurologic Outcome after Severe Traumatic Brain Injury. Scientific Assembly of the National Association of EMS Physicians. Tampa, Florida: National Association of EMS Physicians.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D., Adam, S., Helfenbein, E., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2022, Nov). Nasal Sensor Capnographic Differences in Major Traumatic Brain Injury Patients Receiving Non-Rebreather Mask Versus Nasal Cannula Oxygen Delivery. Circulation. Chicago, IL.
• Gaither, J. B., Spaite, D. W., Bobrow, B. J., Keim, S. M., Barnhart, B. J., Chikani, V., Denninghoff, K. R., Rice, A., & Hu, C. (2022, Jan). Impact of Implementing the Prehospital Treatment Guidelines in Severe TBI Patients with Positive Pressure Ventilation: The EPIC Airway Sub-Analysis. Scientific Assembly of the National Association of EMS Physicians. San Diego, CA: NAEMSP.
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  Gaither JB, Spaite DW, Bobrow BJ, Keim SM, Barnhart BJ, Chikani J, Denninghoff KR, Rice AD, Hu C: Impact of Implementing the Prehospital Treatment Guidelines in Severe TBI Patients with Positive Pressure Ventilation: The EPIC Airway Sub-Analysis. Prehospital Emerg Care 2022;26(1)Jan:109 (Abs #5)
• Gould, J., Lampe, J., Barnhart, B., Spaite, D., & Pandit, S. (2022, Aug). Circadian Pattern of Shockable Rhythms in Out-of-Hospital Cardiac Arrest in Arizona. European Resuscitation Congress. Antwerp, Belgium.
• Hu, C., Keim, S. M., Bradley, G., Rice, A., Gaither, J. B., Spaite, D. W., Barnhart, B. J., & Wohlford, L. (2021, January). Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest. National Association of EMS Physicians Annual Conference. San Diego, California: NAEMSP.
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  Wohlford L, Barnhart BJ, Spaite DW, Gaither JB, Rice AD, Bradley GH, Keim SM, Hu C: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2022;26(1)Jan:155 (Abs #178)
• Keim, S. M., Howard, J. T., Bradley, G., Denninghoff, K. R., Chikani, V., Rice, A., Gaither, J. B., Barnhart, B. J., Bobrow, B. J., Hu, C., & Spaite, D. W. (2021, Aug). Hyperoxia and Outcome Before and After Implementation of the Prehospital Traumatic Brain Injury Guidelines. Scientific Assembly of the National Association of EMS Physicians. San Diego, CA: NAEMSP.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Rice AD, Chikani V, Denninghoff KR, Bradley GH, Howard JT, Keim SM: Hyperoxia and Outcome Before and After Implementation of the Prehospital Traumatic Brain Injury Guidelines. Prehospital Emerg Care 2022;26(1)Jan:111-112 (Abs #13)
• Keim, S. M., Spaite, D. W., Howard, J. T., Hu, C., Bobrow, B. J., Rice, A., Bradley, G., Barnhart, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Gaither, J. B., Chikani, V., Denninghoff, K. R., Barnhart, B. J., Bradley, G., Bobrow, B. J., Rice, A., Howard, J. T., , Hu, C., et al. (2022, Sep). Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure for Predicting Mortality in Major Traumatic Brain Injury . Military Health Systems Research Symposium. Orlando, FL: U.S. Department of Defense.
• Keim, S. M., Spaite, D. W., Howard, J. T., Hu, C., Bobrow, B. J., Rice, A., Bradley, G., Barnhart, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Gaither, J. B., Chikani, V., Denninghoff, K. R., Barnhart, B. J., Bradley, G., Bobrow, B. J., Rice, A., Howard, J. T., , Hu, C., et al. (2022, Sep). The Search for a Physiologically-Meaningful Prehospital Hypotension Threshold in Major Traumatic Brain Injury. Military Health Systems Research Symposium. Orlando, FL: U.S. Department of Defense.
• Rice, A., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Chikani, V., Bradley, G., Keim, S. M., Howard, J. T., & Spaite, D. W. (2022, Jan). In-Field and Early Hospital Hypotension in Major Traumatic Brain Injury: Correlations and Effects on Outcome. Scientific Assembly of the National Association of EMS Physicians. San Diego, CA: NAEMSP.
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  Rice AD, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Chikani V, Bradley GH, Keim SM, Howard JT, Spaite DW. In-Field and Early Hospital Hypotension in Major Traumatic Brain Injury: Correlations and Effects on Outcome. Prehospital Emerg Care 2022;26(1)Jan:110 (Abs #6)
• Spaite, D. W., & Spaite, D. W. (2022, Jan). National EMS Airway Course. National Association of EMS Physicians Scientific Assembly. San Diego, CA: National Association of EMS Physicians.
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  Spaite DW: Ventilation in Intubated EMS Patients: Essential but Forgotten. Presented at the Annual Meeting of the National Association of EMS Physicians, January 12, 2022, San Diego, California. (Invited)
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Adam, S., Gaither, J. B., Rice, A., Keim, S. M., Liu, C., & Hu, C. (2022, Aug). Discrepancies Between Non-Invasive Blood Pressure Monitor Data and EMS Provider Documentation: Are We Missing Hypotension?. European Resuscitation Congress. Antwerp, Belgium.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Rice, A., Chikani, V., Denninghoff, K. R., Bradley, G., Howard, J. T., & Keim, S. M. (2022, Jan). Hyperoxia and Outcome Before and After Implementation of the Prehospital Traumatic Brain Injury Guidelines. Scientific Assembly of the National Association of EMS Physicians. San Diego, CA: NAEMSP.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Rice AD, Chikani V, Denninghoff KR, Bradley GH, Howard JT, Keim SM: Hyperoxia and Outcome Before and After Implementation of the Prehospital Traumatic Brain Injury Guidelines. Prehospital Emerg Care 2022;26(1)Jan:111-112 (Abs #13)
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Rice, A., Chikani, V., Denninghoff, K. R., Bradley, G., Howard, J. T., & Keim, S. M. (2022, Nov). Hypoxia on Arrival at the Hospital Among Major Traumatic Brain Injury Patients Who Were Non-Hypoxic in the Field: Support for “Hyper-oxic” Prehospital Treatment?. Circulation. Chicago, IL.
• Wang, H., Hu, C., Barnhart, B. J., Jansen, J., & Spaite, D. W. (2022, Nov). Long-Term Trajectory of Neurologic Outcome After Severe Traumatic Brain Injury
  . Resuscitation Science Symposium. Chicago, IL.
• Wohlford, L., Barnhart, B. J., Spaite, D. W., Keim, S. M., Gaither, J. B., Rice, A., Hu, C., & Bradley, G. H. (2022, Jan). Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest. Scientific Assembly of the National Association of EMS Physicians. San Diego, CA.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2021, Jan). Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Annual Scientific Assembly of the National Association of EMS Physicians. Virtual National Scientific Assembly.
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  Barnhart B, Spaite DW, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Presented to the Annual Scientific Assembly of the National Association of EMS Physicians, January 13-16, 2021.
• Spaite, D. W. (2021, June). The EPIC Study's Surprising “Airway” Findings...and What They Mean. Montana State EMS Conference on the Implementation of the EMS TBI Guidelines. Butte, MT: State EMS Authority.
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  Spaite DW: EPIC’s Surprising “Airway” Findings and What They Mean. Montana State Conference on Implementation of the Prehospital Traumatic Brain Injury Evidence-Based Guidelines. Bozeman, Montana, June 7, 2021. (Invited)
• Spaite, D. W. (2021, June). The Science of Improving TBI Outcomes: Important Implications for EMS. Montana State EMS Conference on the Implementation of the EMS TBI Guidelines. Butte, MT: State EMS Authority.
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  Spaite DW: The Science of Improving TBI Outcomes: Important Implications for EMS. Montana State Conference on Implementation of the Prehospital Traumatic Brain Injury Evidence-Based Guidelines. Bozeman, Montana, June 7, 2021. (Invited)
• Spaite, D. W. (2021, Sept). Controversies in Prehospital TBI Resuscitation and Airway Management. Annual Meeting of the Montana State Trauma Directors and Coordinators. Butte, MT: State Trauma Directors and Coordinators Program.
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  Spaite DW: Controversies in Prehospital TBI Resuscitation and Airway Management. Presented to the Annual Meeting of the Montana State Trauma Directors and Coordinators. September 8, 2021. (Invited)
• Spaite, D. W. (2021, Sept). Controversies in the Management of Severe Traumatic Brain Injury in the Field: Implications of the Excellence In Prehospital Injury Care Study. Annual Rocky Mountain Rural Trauma Symposium. Butte, MT: Annual Rocky Mountain Rural Trauma Symposium.
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  Spaite DW: Controversies in the Management of Severe Traumatic Brain Injury in the Field: Implications of the Excellence In Prehospital Injury Care Study. Presented to the Annual Rocky Mountain Rural Trauma Symposium. September 8, 2021. (Invited)
• Spaite, D. W. (2021, Sept). The Evidence for Improved Outcomes from Implementing the EMS TBI Guidelines. Annual Meeting of the Montana State Trauma Directors and Coordinators. Butte, MT: State Trauma Directors and Coordinators Program.
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  Spaite DW: The Evidence for Improved Outcomes from Implementing the EMS TBI Guidelines. Presented to the Annual Meeting of the Montana State Trauma Directors and Coordinators. September 8, 2021. (Invited)
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2021, November). Enhanced Prehospital End-Tidal CO2 Monitor Data Analysis for Intubated Severe Traumatic Brain Injury: Striking Findings from the EPIC Study. Resuscitation Science Symposium.
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  Spaite DW, Barnhart B, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Hu C: Enhanced Prehospital End-Tidal CO2 Monitor Data Analysis for Intubated Severe Traumatic Brain Injury: Striking Findings from the EPIC Study. Circulation 2021 (Abstract)
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2021, Jan). Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Annual Scientific Assembly of the National Association of EMS Physicians.
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  Spaite DW, Barnhart B, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discrepancies Between Non-Invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension? Presented to the Annual Scientific Assembly of the National Association of EMS Physicians, January 13-16, 2021.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Chikani, V., Mullins, T., Bradley, G., Denninghoff, K. R., Rice, A., Howard, J. T., & Keim, S. M. (2021, Jan). Impact of Implementing the Prehospital Treatment Guidelines on Outcome in Isolated and Multisystem Traumatic Brain Injury. Annual Scientific Assembly of the National Association of EMS Physician. Virtual National Scientific Assembly.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Keim SM: Impact of Implementing the Prehospital Treatment Guidelines on Outcome in Isolated and Multisystem Traumatic Brain Injury. Presented to the Annual Scientific Assembly of the National Association of EMS Physicians, January 13-16, 2021.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Bradley, G., Rice, A., Howard, J. T., & Keim, S. M. (2021, Jan). Effect of Implementing the Prehospital Traumatic Brain Injury Guidelines on Survival in Severe TBI Patients Transported by Air and Ground EMS. Scientific Assembly of the National Association of EMS Physicians. Virtual National Scientific Assembly.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Keim SM: Effect of Implementing the Prehospital Traumatic Brain Injury Guidelines on Survival in Severe TBI Patients Transported by Air and Ground EMS. Prehosp Emerg Care 2021;25(1)Jan: Abs 93.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Bradley, G., Rice, A., Howard, J. T., & Keim, S. M. (2021, Jan). Optimal Prehospital Blood Pressure in Major Traumatic Brain Injury: Prospective Model Validation Using the Post-Intervention Cohort of the EPIC Study. Scientific Assembly of the National Association of EMS Physicians. Virtual National Scientific Assembly: NAEMSP.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Keim SM: Optimal Prehospital Blood Pressure in Major Traumatic Brain Injury: Prospective Model Validation Using the Post-Intervention Cohort of the EPIC Study. Prehosp Emerg Care 2021;25(1)Jan: Abs 45.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Bradley, G., Rice, A., Howard, J. T., Wang, H., & Keim, S. M. (2021, Jan). Inability of Prehospital Glasgow Coma Scale to Accurately Classify Brain Injury Severity: Has it Doomed TBI Clinical Trials to Failure?. Scientific Assembly of the National Association of EMS Physicians. Virtual National Scientific Assembly.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Wang H, Keim SM: Inability of Prehospital Glasgow Coma Scale to Accurately Classify Brain Injury Severity: Has it Doomed TBI Clinical Trials to Failure? Presented to the Annual Scientific Assembly of the National Association of EMS Physicians, January 13-16, 2021.
• Wohlford, L., Barnhart, B. J., Spaite, D. W., McDannold, R., Bradley, G. H., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2021, Jan). Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. Annual Scientific Assembly of the National Association of EMS Physicians. Virtual National Scientific Assembly.
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  Wohlford L, Barnhart B, Spaite DW, McDannold R, Bradley GH, Rice AD, Gaither JB, Keim SM, Hu C. Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. Presented to the Annual Scientific Assembly of the National Association of EMS Physicians, January 13-16, 2021.
• Wohlford, L., Barnhart, B. J., Spaite, D. W., McDannold, R., Bradley, G. H., Rice, A., Gaither, J. B., Keim, S. M., & Hu, C. (2021, Jan). Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. Scientific Assembly of the National Association of EMS PhysiciansNAEMSP.
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  Wohlford L, Barnhart B, Spaite DW, McDannold R, Bradley GH, Rice AD, Gaither JB, Keim SM, Hu C: Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. Prehospital Emergency Care 2021;25(1)Jan: Abs 39
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2020, November). Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Resuscitation Science Symposium, American Heart Association Scientific Sessions. Virtual National Scientific Conference.
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  Barnhart BJ, Spaite DW, Helfenbein E, Jorgenson D, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Resuscitation Science Symposium, American Heart Association Scientific Sessions. Philadelphia, Pennsylvania, November, 2020.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaieizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2020, Jan). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-tidal CO2 and Level of Consciousness. National Association of EMS Physicians Annual Meeting. January 7-11, 2020, San Diego, CA.
• Gaither, J. B., Jado, I., Bradley, B., Duncan, M., Draper, S., Pike, R., Clark, J., Duran, N. S., Tolson, J. P., Rice, A., & Spaite, D. W. (2020, Jan). In-Station Medication Systems Increase Administration of Controlled Substances During Advanced Life Support (ALS) Transports. Annual Meeting of the National Association of EMS Physicians.
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  Gaither JB, Jado I, Bradley B, Duncan M, Draper S, Pike R, Clark J, Duran NS, Tolson JP, Rice AD, Spaite DW. In-Station Medication Systems Increase Administration of Controlled Substances During Advanced Life Support (ALS) Transports. Presented at the Annual Meeting of the National Association of EMS Physicians, January 9-11, 2020, San Diego, California.
• Salevitz, D., Panczyk, M., Hu, C., & Spaite, D. W. (2020, March). Telephone Cardiopulmonary Resuscitation Process Measures and Survival After Pediatric Out-of-Hospital Cardiac Arrest. College of Medicine-Phoenix Medical Student Research Symposium.
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  Salevitz D, Panczyk M, Hu C, Spaite DW, George T, Mullins T, Nadkarni V, Berg R, Rodriguez S, Chikani V, Bobrow BJ. Telephone Cardiopulmonary Resuscitation Process Measures and Survival After Pediatric Out-of-Hospital Cardiac Arrest. Presented at University of Arizona College of Medicine - Phoenix Research Symposium. March 11, 2020. Phoenix, Arizona.
• Spaite, D. W. (2020, Jan). National EMS Airway Course. National Association of EMS Physicians Scientific Assembly. San Diego, CA: National Association of EMS Physicians.
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  Spaite DW: Ventilation in Intubated EMS Patients: Essential but Forgotten. Presented at the Annual Meeting of the National Association of EMS Physicians, January 6, San Diego, California. (Invited)
• Spaite, D. W. (2020, Mar). The Results and Implications of the Excellence in Prehospital Injury Care Study. Grand Rounds/Visiting Professor, Philips Healthcare Headquarters. Bothell, Washington: Philips Healthcare Headquarters.
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  The Results and Implications of the Excellence in Prehospital Injury Care Study. Grand Rounds: March 18, 2020, Philips Healthcare Headquarters, Bothell, Washington. (Invited)
• Spaite, D. W., & Spaite, D. W. (2020, Jan). The EPIC Prehospital EMS Traumatic Brain Injury Study: Results and Implications. Annual Scientific Meeting of the National Association of EMS Physicians, January 10, 2020, San Diego, California. San Diego, CA: National Association of EMS Physicians.
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  The EPIC Prehospital EMS Traumatic Brain Injury Study: Results and Implications. Plenary Invited Speaker. Presented at the Annual Meeting of the National Association of EMS Physicians, January 10, 2020, San Diego, California. (Invited)
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2020, November). Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Resuscitation Science Symposium, American Heart Association.
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  Spaite DW, Barnhart BJ, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension? Presented at the Resuscitation Science Symposium, American Heart Association. November 14-16, 2020.
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaieizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2020, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring In Non-Intubated Major Traumatic Brain Injury Patients. Annual Meeting of the National Association of EMS Physicians. January 7-11, 2020, San Diego, CA.
• Spaite, D. W., Bobrow, B. J., Gaither, J. B., Barnhart, B. J., Keim, S. M., Chikani, V., Denninghoff, K. R., Mullins, T., Adelson, D., Rice, A., Viscusi, C. D., & Hu, C. (2020, Jan). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: EPIC4Kids Study. Annual Meeting of the National Association of EMS Physicians. January 6-11, 2020, San Diego, CA.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Chikani, V., Mullins, T., Bradley, G., Denninghoff, K. R., Rice, A., & Keim, S. M. (2020, November). Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Resuscitation Science Symposium, American Heart Association.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Chikani V, Mullins T, Bradley G, Denninghoff KR, Rice AD, Keim SM: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Presented at the Resuscitation Science Symposium, American Heart Association. November 14-16, 2020.
• Perez, O., Keim, S. M., Rice, A., Gaither, J. B., Hu, C., Jorgenson, D., Babaeizadeh, S., Helfenbein, E., Spaite, D. W., & Barnhart, B. J. (2019, Jan). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Annual Meeting of the National Association of EMS Physicians. January 7-12, 2019, Austin, TX..
• Spaite, D. W. (2019, April). Keynote Address: Surprising New Findings in the EMS Management of Traumatic Brain Injury: The EPIC Study. Annual Science Symposium of the American College of Emergency Physicians-Wisconsin. Milwaukee, WI: American College of Emergency Physicians-Wisconsin Chapter.
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  Keynote Address: Surprising New Findings in the EMS Management of Traumatic Brain Injury: The EPIC Study. Presented to the Annual Science Symposium of the American College of Emergency Physicians-Wisconsin, Milwaukee, WI, April 3, 2019
• Spaite, D. W. (2019, Aug). Ventilation: The Forgotten Essential of Resuscitation. National Association of EMS Physicians. San Diego, CA: National Association of EMS Physicians.
• Spaite, D. W. (2019, Jan). Post-Intubation Ventilation in EMS: Preventing Inadvertent Ventilatory Inattentiveness.. Annual Meeting of the National Association of EMS Physicians. Austin, Texas: National Association of EMS Physicians.
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  Post-Intubation Ventilation in EMS: Preventing Inadvertent Ventilatory Inattentiveness. Presented at the Annual Meeting of the National Association of EMS Physicians, January 7-12, 2019, Austin, Texas
• Spaite, D. W. (2019, Jul). The EPIC4Kids EMS Traumatic Brain Injury Study: Big Implications for Little Ones. Invited Plenary Presentation at the Annual Scientific Meeting of the Western Pediatric Trauma Conference. Telluride, CO: Annual Scientific Meeting of the Western Pediatric Trauma Conference.
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  The EPIC4Kids EMS Traumatic Brain Injury Study: Big Implications for Little Ones. Invited Plenary Presentation at the Annual Scientific Meeting of the Western Pediatric Trauma Conference. Telluride, Colorado; July 17, 2019. (Invited)
• Spaite, D. W. (2019, Nov). Annual Pat Petersen Keynote Address: The Excellence In Prehospital Injury Care (EPIC) Traumatic Brain Injury Study: Results and Implications for the Management of Major TBI Patients in Air Medical Transport. Annual Pat Petersen Keynote Address:. Atlanta, GA: Annual Scientific Meeting of the Air Medical Physicians’ Association (AMPA).
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  Annual Pat Petersen Keynote Address: The Excellence In Prehospital Injury Care (EPIC) Traumatic Brain Injury Study: Results and Implications for the Management of Major TBI Patients in Air Medical Transport. Keynote Address for the Annual Scientific Meeting of the Air Medical Physicians’ Association (AMPA), November 3, 2019. Atlanta, Georgia (Invited)
• Spaite, D. W. (2019, Nov). Keynote Address: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines: Implications for the Future of EMS Care. Keynote Address: California State EMS Authority Annual Trauma Symposium. San Diego, California: California State EMS Authority Annual Trauma Symposium.
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  Keynote Address: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines: Implications for the Future of EMS Care. California State EMS Authority Annual Trauma Symposium, May 12, 2020, San Diego, California. (Invited)
• Spaite, D. W. (2019, Nov). Special Year-in-Review Presentation: The Excellence In Prehospital Injury Care (EPIC) Traumatic Brain Injury Study: Results and Implications. Annual Resuscitation Science Symposium, American Heart Association. Philidelphia, PA: Resuscitation Science Symposium, American Heart Association.
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  Special Year-in-Review Presentation: The Excellence In Prehospital Injury Care (EPIC) Traumatic Brain Injury Study: Results and Implications. Presented at the Resuscitation Science Symposium, American Heart Association. November 16-17, 2019; Philadelphia, Pennsylvania (Invited)
• Spaite, D. W. (2019, Nov). The Excellence In Prehospital Injury Care (EPIC) Traumatic Brain Injury Study: Results and Implications for Future Development of Real-Time AudioVisual Feedback Technology in TBI Management. Grand Rounds/Visiting Professor. ZOLL Medical International Headquarters, Chelmsford, Massachusetts.
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  The Excellence In Prehospital Injury Care (EPIC) Traumatic Brain Injury Study: Results and Implications for Future Development of Real-Time AudioVisual Feedback Technology in TBI Management. Presented at Grand Rounds, November 6, 2019, ZOLL Medical International Headquarters, Chelmsford, Massachusetts (Invited).
• Spaite, D. W. (2019, Nov). The Results and Implications of the Excellence in Prehospital Injury Care Study. Grand Rounds/Visiting Professor, Philips Healthcare Headquarters. Bothell, Washington: Philips Healthcare Headquarters.
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  The Results and Implications of the Excellence in Prehospital Injury Care Study. Grand Rounds: March 18, 2020, Philips Healthcare Headquarters, Bothell, Washington. (Invited)
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhardt, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2018, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. NAEMSP National Scientific Assembly.
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhardt, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2018, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emergency Care.
• Spaite, D. W. (2018, Jan). Ventilation in Intubated EMS Patients: Essential but Forgotten. National Association of EMS Physicians Annual Meeting. San Diego, CA.
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  Spaite DW: Ventilation in Intubated EMS Patients: Essential but Forgotten. Presented at the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, CA. (Invited)
• Spaite, D. W., & Spaite, D. W. (2018, Jan). Major Traumatic Brain Injury in EMS Patients: New and Surprising Findings from the EPIC Study. National Association of EMS Physicians Annual Meeting. San Diego, CA.
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  Spaite DW: Major Traumatic Brain Injury in EMS Patients: New and Surprising Findings from the EPIC Study. Presented at the Annual Meeting of the National Association of EMS Physicians, January 10-13, 2018, San Diego, CA. (Invited))
• Spaite, D. W. (2017, Jan). Major Traumatic Brain Injury in EMS Patients: New and Surprising Findings from the EPIC Study. National Association of EMS Physicians Annual Meeting. New Orleans, LA.
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  Spaite DW: Major Traumatic Brain Injury in EMS Patients: New and Surprising Findings from the EPIC Study. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA. (Invited)
• Spaite, D. W. (2017, Jan). Ventilation in Intubated EMS Patients: Essential but Forgotten. National Association of EMS Physicians Annual Meeting. New Orleans, LA.
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  Spaite DW: Ventilation in Intubated EMS Patients: Essential but Forgotten. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA. (Invited)
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, Nov). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2016;133:A15795
• Beger, S., Sutter, J., Hu, C., Spaite, D. W., Silver, A., McDannold, R., Mullins, M., Vadeboncoeur, T., & Bobrow, B. J. (2016, Nov). Decline in Chest Compression Release Velocity Over Time is Associated With Out-of-Hospital Cardiac Arrest Outcomes. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Beger S, Sutter J, Hu C, Spaite D, Silver A, McDannold R, Mullins M, Vadeboncoeur T, Bobrow B. 2016. Decline in Chest Compression Release Velocity Over Time is Associated With Out-of-Hospital Cardiac Arrest Outcomes. Circulation. 134 (Suppl 1): A20257.
• Fukushima, H., Silver, A., Gould, J., Edgell, K., Appleby, D., Iwami, T., Mullins, M., McDannold, R., & Bobrow, B. J. (2016, November). Predictors of Resuscitation Success Prior to EMS Arrival in Out-of-Hospital Cardiac Arrest Patients Treated with a Public Access AED. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., Bobrow, B. J., Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., , Viscusi, C. D., et al. (2016, January). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Annual Meeting of the National Association of EMS Physicians. San Diego.
• Gaither, J. B., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Spaite, D. W. (2016, January 14-16). Age-Related Risk of Death in Patients With Major TBI: Implications for Trauma Triage Guidelines.. National Association of EMS Physicians Annual Meeting. San Diego, CA.
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  Gaither JB, Hu C, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, Adelson PD, Viscusi C, Denninghoff KR, Spaite DW. 2016. Age-Related Risk of Death in Patients With Major TBI: Implications for Trauma Triage Guidelines. Prehospital Emerg Care 2016;20(1):164.
• Hu, C., Spaite, D. W., Silver, A., Gaither, J. B., McDannold, R., Mullins, M., Vadeboncoeur, T., & Bobrow, B. J. (2016, Nov). Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Hu C, Spaite D, Silver A, Gaither J, McDannold R, Mullins M, Vadeboncoeur T, Bobrow BJ. 2016. Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Circulation. 134 (Suppl 1): A20338.
• Panczyk, M., Sutter, J., Langlais, B., Hu, C., Vadeboncoeur, T., Mullins, T., Spaite, D. W., & Bobrow, B. J. (2016, Nov). Telephone CPR is Independently Associated With an Increase in Initial Shockable Rhythms in Patients With Out-of-Hospital Cardiac Arrest. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Panczyk M, Sutter J, Langlais B, Hu C, Vadeboncoeur T, Mullins T, Spaite D, Bobrow B. 2016. Telephone CPR is Independently Associated With an Increase in Initial Shockable Rhythms in Patients With Out-of-Hospital Cardiac Arrest. Circulation. 134 (Suppl 1): A13846.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. L. (2016, November). Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Adelson PD, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. Circulation 2016;A15910
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Viscusi, C. D., Mullins, T., Martinez, R. A., & Adelson, P. D. (2016, January 14-16). Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. National Association of EMS Physicians Annual Meeting. San Diego, CA.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Sherrill DL, Barnhart BJ, Gaither JB, Denninghoff KR, Viscusi CD, Mullins T, Martinez RA, and Adelson PD. 2016. Comparison of the performance of prehospital systolic blood pressure versus calculated mean arterial pressure in predicting mortality in major traumatic brain injury. Prehospital Emerg Care, 2016;20(1):137.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Viscusi, C. D., Mullins, T., Stolz, U., & Adelson, P. D. (2016, January). Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. Annual Meeting of the National Association of EMS Physicians. San Diego, California.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2016, January 14-16). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study.. National Association of EMS Physicians Annual Meeting. San Diego, CA.
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  Spaite DW, Hu C, Bobrow BJ, Sherrill DL, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Adelson PD, Viscusi CD, Mullins T, and Stolz U. 2016. Association between survival and increases in prehospital systolic blood pressure after its nadir in major traumatic brain injury: new findings from the EPIC study. Prehospital Emerg Care, 2016;20(1):140-141.
• Gaither, J. B., Chikani, V., Spaite, D. W., Stolz, U., Garison, S., Smith, J., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2015, January). Association Between Initial Trauma Center Body Temperature and Mortality from Major Traumatic Brain Injury.. Annual Meeting of the National Association of EMS Physicians. New Orleans, Louisiana.

Poster Presentations

• Rice, A., Munn, R., Hannan, P., Spaite, D. W., & Gaither, J. B. (2024, January 8 - 13).

  Young Adult Willingness to use Automated Defibrillators and Perspectives on Early Bystander Defibrillation: Wise JN, Rice AD, Lara JV, Munn, Knotts MR, Hannan PL, Spaite DW, Gaither JB.

  . Presented at the Annual Scientific Assembly of the National Association of EMS Physicians.. Austin, Texas.
• Rice, A., Spaite, D. W., Munn, R., Hannan, P., & Gaither, J. B. (2024, January). A liberal shocking strategy distorts Utstein survival calculation for out of hospital cardiac arrests: Knotts MC, Gaither JB, Hannan PL, Hollen A, Munn R, Spaite DW, Johnson H, Keeley B, Twilling S, Rice AD.   . National Association of EMS Physicians Annual Scientific Assembly. Austin, Texas.
• Keim, S. M., Barnhart, B. J., Hu, C., Gaither, J. B., Rice, A. M., Spaite, D. W., & Keim, S. M. (2020, Oct). Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Annual Meeting of the American Heart Association.
• Keim, S. M., Rice, A., Denninghoff, K. R., Bradley, G., Mullins, T., Chikani, V., Gaither, J. B., Barnhart, B. J., Bobrow, B. J., Hu, C., & Spaite, D. W. (2020, November). Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Resuscitation Science Symposium, American Heart Association.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Chikani V, Mullins T, Bradley G, Denninghoff KR, Rice AD, Keim SM: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Presented at the Resuscitation Science Symposium, American Heart Association. November 14-16, 2020.
• Spaite, D. W., Barnhart, B. J., Gaither, J. B., Rice, A. M., Keim, S. M., & Hu, C. (2020, October). Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Annual meeting of the American Heart Association.
• Barnhart, B. J., Keim, S. M., Rice, A., Gaither, J. B., Hu, C., Jorgenson, D., Babaeizadeh, S., Helfenbein, E., Spaite, D. W., & Perez, O. (2019, Jan). Prehospital End-Tidal CO2 Measurement in Non-Intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-invasive Monitor Data Tracking. Annual Meeting of the National Association of EMS Physicians. January 7-12, 2019, Austin, TX..
• Bobrow, B. J., Spaite, D. W., Mullins, M., Hu, C., Gaither, J. B., Rice, A., & Maher, S. A. (2019, Nov). Cardiopulmonary Resuscitation Prior to Arrival of Emergency Medical Services in Arizona Extended Care Facilities. Annual Meeting of the American Heart Association, Resuscitation Science Symposium. Nov. 16–17, 2019, Philadelphia, Pennsylvania.
• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaieizadeh, S., Jorgenson, D., Helfenbein, E., Barnhart, B. J., & Spaite, D. W. (2019, Fall). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring In Non-Intubated Major Traumatic Brain Injury Patients. Annual Meeting of the American Heart Association, Resuscitation Science Symposium. Nov. 16–17, 2019 Philadelphia, Pennsylvania.
• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaieizadeh, S., Jorgenson, D., Helfenbein, E., Spaite, D. W., & Barnhart, B. J. (2019, Fall). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-Tidal CO2 and Level of Consciousness. Annual Meeting of the American Heart Association, Resuscitation Science Symposium. Nov. 16–17, 2019 Philadelphia, Pennsylvania.
• Hu, C., Viscusi, C. D., Rice, A., D, A., T, M., Denninghoff, K. R., V, C., Barnhart, B. J., Keim, S. M., Gaither, J. B., Bobrow, B. J., & Spaite, D. W. (2019, Fall). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: EPIC4Kids Study. Annual Meeting of the American Heart Association, Resuscitation Science Symposium. Nov. 16–17, 2019 Philadelphia, Pennsylvania.
• Keim, S. M., Rice, A., Denninghoff, K. R., Gaither, J. B., Chikani, V., Barnhart, B. J., Bobrow, B. J., Hu, C., & Spaite, D. W. (2019, Jan). Differential Effects of Prehospital Hypotension and Injury Severity in Isolated versus Multisystem Major Traumatic Brain Injury. Annual Meeting of the National Association of EMS Physicians. January 7-12, 2019, Austin, TX..

Others

• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2021, November). Enhanced Prehospital End-Tidal CO2 Monitor Data Analysis for Intubated Severe Traumatic Brain Injury: Striking Findings from the EPIC Study. Circulation.
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  Spaite DW, Barnhart B, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Hu C: Enhanced Prehospital End-Tidal CO2 Monitor Data Analysis for Intubated Severe Traumatic Brain Injury: Striking Findings from the EPIC Study. Circulation 2021 (Abstract)
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2021, Jan). Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Prehospital Emergency Care.
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  Spaite DW, Barnhart B, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discrepancies Between Non-Invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension? Prehosp Emerg Care 2021;25(1)Jan: Abs 100.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Chikani, V., Mullins, T., Bradley, G., Denninghoff, K. R., Rice, A., Howard, J. T., & Keim, S. M. (2021, Jan). Impact of Implementing the Prehospital Treatment Guidelines on Outcome in Isolated and Multisystem Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Bradley GH, Rice AD, Howard JT, Keim SM: Impact of Implementing the Prehospital Treatment Guidelines on Outcome in Isolated and Multisystem Traumatic Brain Injury. Prehosp Emerg Care 2021;25(1)Jan: Abs 125
• Wohlford, L., Wohlford, L., Barnhart, B. J., Barnhart, B. J., Spaite, D. W., Spaite, D. W., McDannold, R., McDannold, R., Bradley, G. H., Bradley, G. H., Rice, A., Rice, A., Gaither, J. B., Gaither, J. B., Keim, S. M., Keim, S. M., Hu, C., & Hu, C. (2021, Jan). Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. Prehospital Emergency Care.
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  Wohlford L, Barnhart B, Spaite DW, McDannold R, Bradley GH, Rice AD, Gaither JB, Keim SM, Hu C: Disparities in Rural CPR Delivery and Outcomes from Out-of-Hospital Cardiac Arrest in Arizona. Prehospital Emergency Care 2021;25(1)Jan: Abs 39
• Barnhardt, B. J., Barnhardt, B. J., Spaite, D. W., Spaite, D. W., Helfenbein, E., Helfenbein, E., Jorgenson, D. B., Jorgenson, D. B., Babaeizadeh, S., Babaeizadeh, S., Gaither, J. B., Gaither, J. B., Rice, A., Rice, A., Keim, S. M., Keim, S. M., Hu, C., & Hu, C. (2020, Jan). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-Tidal CO2 and Level of Consciousness. Prehospital Emergency Care.
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  Barnhart BJ, Spaite DW, Helfenbein E, Jorgenson D, Babaeizadeh S, Gaither JB, Rice A, Keim SM, Hu C: Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-tidal CO2 and Level of Consciousness. Prehospital Emerg Care 2020 (in press).
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2020, November). Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Circulation.
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  Barnhart BJ, Spaite DW, Helfenbein E, Jorgenson D, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Circulation. November, 2020. Abstract
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D., Babaieizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2020, Jan). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-tidal CO2 and Level of Consciousness. Prehospital Emergency Care, 24(1), 100-156 (Abstracts for the 2020 NAEMSP Scientific Assembly).
• Gaither, J. B., Gaither, J. B., Isrelia, J., Isrelia, J., Brad, B., Brad, B., Michael, D., Michael, D., Richard, P., Richard, P., John, C., John, C., N, D., N, D., Jeffery, T., Jeffery, T., Rice, A., Rice, A., Spaite, D. W., & Spaite, D. W. (2020, Jan). In-Station Medication Systems Increase Administration of Controlled Substances During Advanced Life Support (ALS) Transports. Prehospital Emergency Care.
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  Gaither JB, Jado I, Bradley B, Duncan M, Draper S, Pike R, Clark J, Duran NS, Tolson JP, Rice AD, Spaite DW. In-Station Medication Systems Increase Administration of Controlled Substances During Advanced Life Support (ALS) Transports. Prehospital Emergency Care 2020
• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaieizadeh, S., Jorgenson, D., Helfenbein, E., Barnhart, B. J., & Spaite, D. W. (2020, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring In Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emergency Care, 24(1), 100-156 (Abstracts for the 2020 NAEMSP Scientific Assembly).
• McDannold, R., Hu, C., Spaite, D. W., Silver, A. E., Mullins, M., Mullins, T., Chikani, V., Bradley, G., Gaither, J. B., Rice, A., Bobrow, B. J., Glenn, M., Keim, S. M., & Barnhart, B. J. (2020, Nov). Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests. Circulation. https://www.ahajournals.org/doi/10.1161/circ.142.suppl_4.156
• Spaite, D. W., Barnhart, B. J., Gaither, J. B., Rice, A. M., Keim, S. M., & Hu, C. (2020, October). Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Circulation.
• Spaite, D. W., Barnhart, B. J., Helfenbein, E., Jorgenson, D., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., Bradley, G., & Hu, C. (2020, November). Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Circulation.
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  Spaite DW, Barnhart BJ, Helfenbein E, Jorgenson DB, Babaeizadeh S, Gaither JB, Rice AD, Keim SM, Bradley G, Hu C: Discrepancies Between Non-invasive Blood Pressure Monitor Data and EMS Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension? Circulation 2020 (Abstract)
• Spaite, D. W., Bobrow, B. J., Gaither, J. B., Barnhart, B. J., Keim, S. M., Chikani, V., Denninghoff, K. R., Mullins, T., Adelson, D., Rice, A., Viscusi, C. D., & Hu, C. (2020, Jan). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: EPIC4Kids Study. Prehospital Emergency Care, 24(1), 100-156 (Abstracts for the 2020 NAEMSP Scientific Assembly).
• Spaite, D. W., Bobrow, B. J., Gaither, J. B., Keim, S. M., Barnhart, B. J., V, C., Denninghoff, K. R., T, M., D, A., Rice, A., Viscusi, C. D., & Hu, C. (2020, Jan). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: EPIC4Kids Study. Prehospital Emerency Care.
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  Spaite DW, Bobrow BJ, Gaither JB, Barnhart BJ, Keim SM, Chikani V, Denninghoff K, Mullins T, Adelson D, Rice AD, Viscusi C, Hu C: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: Results of the EPIC4Kids Study. Prehospital Emerg Care 2020 (in press).
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B. J., Gaither, J. B., Chikani, V., Mullins, T., Bradley, G., Denninghoff, K. R., Rice, A., & Keim, S. M. (2020, November). Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Gaither JB, Chikani V, Mullins T, Bradley G, Denninghoff KR, Rice AD, Keim SM: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Circulation 2020 (Nov)
• Barnhardt, B. J., Barnhardt, B. J., Barnhardt, B. J., Barnhart, B. J., Spaite, D. W., Spaite, D. W., Spaite, D. W., Spaite, D. W., Helfenbein, E., Helfenbein, E., Helfenbein, E., Helfenbein, E., Babaeizadeh, S., Babaeizadeh, S., Babaeizadeh, S., Babaeizadeh, S., Jorgenson, D. B., Jorgenson, D., Jorgenson, D. B., , Jorgenson, D. B., et al. (2019, Jan). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Prehospital Emergency Care.
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  Barnhart BJ, Spaite DW, Helfenbein E, Babaieizadeh S, Jorgenson D, Hu C, Gaither JB, Rice A, Keim SM, Perez O: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Prehospital Emerg Care 2019
• Barnhardt, B. J., Spaite, D. W., Helfenbein, E., Jorgenson, D. B., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2019, Fall). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between Ent-Tidal CO2 and Level of Consciousness. Circulation.
• Barnhart, B. J., Keim, S. M., Rice, A., Gaither, J. B., Hu, C., Jorgenson, D., Babaeizadeh, S., Helfenbein, E., Spaite, D. W., & Perez, O. (2019, Jan). Prehospital End-Tidal CO2 Measurement in Non-Intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-invasive Monitor Data Tracking. Prehospital Emergency Care, 23(1)..
• Bobrow, B. J., Spaite, D. W., Mullins, M., Hu, C., Gaither, J. B., Rice, A., & Maher, S. A. (2019, Nov). Cardiopulmonary Resuscitation Prior to Arrival of Emergency Medical Services in Arizona Extended Care Facilities. Circulation. 2019;140:A291.
• Enriquez, N. A., Janajreh, Y. M., Tolson, J. P., Mhayamaguru, K., Rice, A., Smith, J., Spaite, D. W., Draper, S., Duncan, M., & Gaither, J. B. (2019, Jan). Case Series Illustrating Adverse Reactions to Prehospital Administration of Low Dose Ketamine for Pain Control. Prehospital Emergency Care.
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  Enriquez NA, Janajreh YM, Tolson JP, Mhayamaguru KM, Rice AD, Smith JJ, Spaite DW, Draper S, Duncan D, Gaither JB. Case Series Illustrating Adverse Reactions to Prehospital Administration of Low Dose Ketamine for Pain Control. Prehospital Emerg Care 2019
• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaieizadeh, S., Jorgenson, D., Helfenbein, E., Barnhart, B. J., & Spaite, D. W. (2019, Fall). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring In Non-Intubated Major Traumatic Brain Injury Patients. Circulation. 2019;140:A326.
• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaieizadeh, S., Jorgenson, D., Helfenbein, E., Spaite, D. W., & Barnhart, B. J. (2019, Fall). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-Tidal CO2 and Level of Consciousness. Circulation. 2019;140:A386.
• Hu, C., Viscusi, C. D., Rice, A., D, A., T, M., Denninghoff, K. R., V, C., Barnhart, B. J., Keim, S. M., Gaither, J. B., Bobrow, B. J., & Spaite, D. W. (2019, Fall). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: EPIC4Kids Study. Circulation. 2019;140:A320.
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  Circulation. 2019;140:A291
• Keim, S. M., Rice, A., Denninghoff, K. R., Gaither, J. B., Chikani, V., Barnhart, B. J., Bobrow, B. J., Hu, C., & Spaite, D. W. (2019, Jan). Differential Effects of Prehospital Hypotension and Injury Severity in Isolated versus Multisystem Major Traumatic Brain Injury. Prehospital Emergency Care, 23(1)..
• Maher, S., Rice, A. D., Gaither, J. B., Hu, C., Mullins, M., Spaite, D. W., & Bobrow, B. J. (2019, November). Cardiopulmonary Resuscitation Prior to Arrival of Emergency Medical Services in Arizona Extended Care Facilities. Circulation.
• Perez, O., Keim, S. M., Rice, A., Gaither, J. B., Hu, C., Jorgenson, D., Babaeizadeh, S., Helfenbein, E., Spaite, D. W., & Barnhart, B. J. (2019, Jan). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Prehospital Emergency Care, 23(1)..
• Perez, O., Perez, O., Perez, O., Spaite, D. W., Spaite, D. W., Spaite, D. W., Helfenbein, E., Helfenbein, E., Helfenbein, E., Babaeizadeh, S., Babaeizadeh, S., Babaeizadeh, S., Jorgenson, D. B., Jorgenson, D. B., Jorgenson, D. B., Hu, C., Hu, C., Hu, C., Gaither, J. B., , Gaither, J. B., et al. (2019, Jan). Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emergency Care.
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  Perez O, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson D, Hu C, Gaither JB, Rice A, Keim SM, Barnhart BJ: Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emerg Care 2019
• Spaite, D. W., Barnhardt, B. J., Helfenbein, E., Jorgenson, D. B., Babaeizadeh, S., Gaither, J. B., Rice, A., Keim, S. M., & Hu, C. (2019, Fall). Prehospital Use of Nasal Cannual End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation.
• Spaite, D. W., Bobrow, B. J., Gaither, J. B., Keim, S. M., Barnhart, B. J., V, C., Denninghoff, K. R., T, M., D, A., Rice, A., Viscusi, C. D., & Hu, C. (2019, Nov). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: EPIC4Kids Study. Circulation.
• Spaite, D. W., Spaite, D. W., Spaite, D. W., Hu, C., Hu, C., Hu, C., Bobrow, B. J., Bobrow, B. J., Bobrow, B. J., Barnhardt, B. J., Barnhardt, B. J., Barnhardt, B. J., Chikani, V., Chikani, V., Chikani, V., Gaither, J. B., Gaither, J. B., Gaither, J. B., Denninghoff, K. R., , Denninghoff, K. R., et al. (2019, Jan). Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart BJ, Chikani V, Gaither JB, Denninghoff K, Rice A, Keim SM: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. Prehospital Emerg Care 2019
• Barnhardt, B. J., Spaite, D. W., Helfenbein, E., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Gaither, J. B., Rice, A., Keim, S. M., & Perez, O. (2018, Nov). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Circulation.
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  Barnhart B, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson DB, Hu C, Gaither JB, Rice AD, Keim SM, Perez O: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Circulation 2018
• Berger, S., Smith, G., Chikani, V., Spaite, D. W., Keim, S. M., Mullins, T., George, T., & Bobrow, B. J. (2018, Jan). Statewide Trends in Out-of-Hospital Cardiac Arrest Related to Drug Overdose. Prehospital Emergency Care.
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  Beger S, Smith G, Chikani V, Spaite D, Keim S, Mullins T, George T, Bobrow B: Statewide Trends in Out-of-Hospital Cardiac Arrest Related to Drug Overdose. Prehospital Emerg Care 2018;22(1):102.
• Bobrow, B. J., Panczyk, M., Blust, R., Brazil, P., George, T., Chikani, V., Hu, C., & Spaite, D. W. (2018, Jan). Death by Suicide: The EMS Profession Compared to the General Public. Prehospital Emergency Care.
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  Bobrow BJ, Panczyk M, Blust R, Brazil P, George T, Chikani V, Hu C, Spaite DW: Death by Suicide: The EMS Profession Compared to the General Public. Prehospital Emerg Care 2018;22(1):102.
• Gaither, J. B., Gaither, J. B., Mhayamaguru, K., Mhayamaguru, K., Rice, A., Rice, A., Waters, K. E., Waters, K. E., Smith, J. J., Smith, J. J., Beskind, D. L., Beskind, D. L., Spaite, D. W., & Spaite, D. W. (2018, Jan). Use of Distance Education Tools to Improve the Rural EMS Experience for EMS Fellows. Prehospital Emergency Care.
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  Gaither JB, Mhayamaguru KM, Rice A, Waters KE, Smith JJ, Beskind D, Spaite DW. Use of Distance Education Tools to Improve the Rural EMS Experience for EMS Fellows. Prehospital Emerg Care 2018;22(1):152-153.
• Gaither, J. B., Rice, A., Hu, C., McDannold, R., Mullins, M., Spaite, D. W., Vadeboncoeur, T. F., George, T., Mullins, T., & Bobrow, B. J. (2018, Jan). Comparison of Manual Vs. Mechanical Chest Compression Quality During Prehospital Cardiac Resuscitation. Prehospital Emergency Care.
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  Gaither J, Rice A, Hu C, McDannold R, Mullins M, Spaite D, Vadeboncoeur T, George T, Mullins T, Bobrow B: Comparison of Manual Vs. Mechanical Chest Compression Quality During Prehospital Cardiac Resuscitation. Prehospital Emerg Care 2018;22(1):122-123.
• Perez, O., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Jorgenson, D., Hu, C., Chikani, V., Gaither, J. B., Keim, S. M., Sherril, D., & Spaite, D. W. (2018, Jan). Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emergency Care.
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  Perez O, Helfenbein E, Barnhart BJ, Babaeizadeh S, Jorgenson D, Hu C, Chikani V, Gaither J, Keim S, Sherrill D, Spaite D: Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emerg Care 2018;22(1):123-124.
• Perez, O., Spaite, D. W., Helfenbein, E., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Gaither, J. B., Rice, A., Keim, S. M., & Barnhardt, B. J. (2018, Nov). Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation.
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  Perez O, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson DB, Hu C, Gaither JB, Rice AD, Keim SM, Barnhart B: Prehospital End-Tidal CO2 Measurement in Non-intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation 2018
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhardt, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2018, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emergency Care.
• Rice, A., Gaither, J. B., Spaite, D. W., Chikani, V., Wentworth, S., Vadeboncoeur, T. F., George, T., Mullins, T., & Bobrow, B. J. (2018, Jan). Rearrest Incidence and Post-ROSC Rhythms after Prehospital Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest. Prehospital Emergency Care.
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  Rice A, Gaither J, Spaite D, Chikani V, Wentworth S, Vadeboncoeur T, George T, Mullins T, Bobrow B: Rearrest Incidence and Post-ROSC Rhythms after Prehospital Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2018;22(1):120.
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhardt, B. J., Chikani, V., Gaither, J. B., Denninghoff, K. R., Rice, A., & Keim, S. M. (2018, Nov). Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart B, Chikani V, Gaither JB, Denninghoff KR, Rice AD, Keim SM: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated Versus Multisystem Major Traumatic Brain Injury. Circulation 2018
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhardt, B. J., Chikani, V., Gaither, J. B., Denninghoff, K. R., Rice, A., & Keim, S. M. (2018, Nov). Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Barnhart B, Chikani V, Gaither JB, Denninghoff KR, Rice AD, Keim SM: Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. Circulation 2018
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Viscusi, C. D., Sherrill, D. L., & Keim, S. M. (2017, Sept). Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Viscusi C, Sherrill D, Keim SM: Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2018;22(1):105-106.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Viscusi, C. D., Sherrill, D. L., & Keim, S. M. (2018, Jan). Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Viscusi C, Sherrill D, Keim SM: Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2018;22(1):105-106.
• Sutter, J. H., Beger, S., Hu, C., Spaite, D. W., Silver, A., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2018, Nov). Associations of Chest Compression Release Velocity and Age, Weight, and Gender During Cardiac Resuscitation. Circulation.
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  Sutter JH, Beger S, Hu C, Spaite DW, Silver A, McDannold R, Mullins M, Vadeboncoeur T, Bobrow BJ: Associations of Chest Compression Release Velocity and Age, Weight, and Gender During Cardiac Resuscitation. Circulation 2018;138 (Suppl 2); Abs 260
• Barnhardt, B. J., Helfenbein, E., Perez, O., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Chikani, V., Gaither, J. B., Sherill, D., Keim, S. M., & Spaite, D. W. (2017, Nov). Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. Circulation.
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  Barnhart BJ, Helfenbein E, Perez O, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Sherrill D, Keim SM, Spaite DW: Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2017
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherril, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, Jan). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emerg Care 2017:21(1):95.
• Beger, S., Sutter, J., Hu, C., Spaite, D. W., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2017, Jan). Decline in Chest Compression Velocity Over Time is Related to Out-Of-Hospital Cardiac Arrest Outcome. Prehospital Emergency Care.
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  Beger S, Sutter J, Hu C, Spaite D, McDannold R, Mullins M, Vadeboncoeur TF, Bobrow BJ: Decline in Chest Compression Velocity Over Time is Related to Out-Of-Hospital Cardiac Arrest Outcome. Prehospital Emerg Care 2017:21(1):100.
• Gaither, J. B., Rice, A., Hu, C., Silver, A., McDannold, R., Mullins, M., Spaite, D. W., Vadeboncoeur, T. F., George, T. A., Mulllins, T., & Bobrow, B. J. (2017, Nov). Comparison of Manual vs. Mechanical Chest Compression Quality during Prehospital Cardiac Resuscitation. Circulation.
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  Gaither JB, Rice AD, Hu C, Silver A, McDannold R, Mullins M, Spaite DW, Vadeboncoeur TF, George TA, Mullins T, Bobrow BJ: Comparison of Manual vs. Mechanical Chest Compression Quality during Prehospital Cardiac Resuscitation. Circulation 2017 (in press)
• Hu, C., Spaite, D. W., Silver, A., Gaither, J. B., McDannold, R., Mullins, T., Vadeboncoeur, T. F., & Bobrow, B. J. (2017, Jan). Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Prehospital Emergency Care.
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  Hu C, Spaite DW, Silver A, Gaither J, McDannold R, Mullins M, Vadeboncoeur T, Bobrow B. Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Prehospital Emerg Care 2017:21(1):92.
• Langlais, B., Sutter, J., Bohm, K., Panczyk, M., Hu, C., Spaite, D. W., & Bobrow, B. J. (2017, Jan). Telecommunicator Breathing Assessment Techniques in Out-Of-Hospital Cardiac Arrest. Prehospital Emergency Care.
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  Langlais B, Sutter J, Bohm K, Panczyk M, Hu C, Spaite DW, Bobrow BJ: Telecommunicator Breathing Assessment Techniques in Out-Of-Hospital Cardiac Arrest. Prehospital Emerg Care 2017:21(1):124-125.
• Perez, O., Helfenbein, E., Barnhardt, B. J., Babaeizadeh, S., Jorgenson, D. B., Hu, C., Chikani, V., Gaither, J. B., Keim, S. M., Sherill, D., & Spaite, D. W. (2017, Nov). Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation.
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  Perez O, Helfenbein E, Barnhart BJ, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Keim SM, Sherrill D, Spaite DW: Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation 2017
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhardt, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emergency Care.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Rice AD, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emerg Care 2017:21(1):97.
• Spaite, D. W., Bobrow, B. J., Gaither, J. B., & Hu, C. (2017, Feb). In reply. Annals of emergency medicine.
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  Spaite DW, Bobrow BJ, Gaither JB, Hu C: In reply: The Effect of Combined Out-of-Hospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. (Reply to Broder JS: Words Matter: Researchers Should Avoid Implying Causation in Studies of Association. Ann Emerg Med 2017;70(2):262-264. doi: 10.1016/j.annemergmed.2017.03.015
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B. J., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Mullins, T., Sherrill, D., & Keim, S. M. (2017, Nov). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Mullins T, Sherrill D, Keim SM: Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation 2017
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B. J., Adelson, P. D., Rice, A. D., Grady, K., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherril, D. (2017, Jan). Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart BJ, Adelson PD, Rice AD, Grady K, Denninghoff KR, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2017:21(1):91.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Viscusi, C. D., Mullins, T., Sherrill, D. L., & Keim, S. M. (2017, November). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation 2017;136(Suppl 1):A14729..
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart BJ, Adelson PD, Denninghoff KR, Rice AD, Viscusi C, Mullins T, Sherrill D, Keim SM. Evaluation of the Combined Prehospital Hypoxia-Hypotension ``Depth-Duration Dose'' and Mortality in Major Traumatic Brain Injury. Circulation 2017;136(Suppl 1):A14729
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, Nov). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2016;A15795
• Beger, S., Sutter, J., Hu, C., Spaite, D. W., Silver, A., McDannold, R., Mullins, M., Vadebencoeur, T. F., & Bobrow, B. J. (2016, November). Decline in Chest Compression Release Velocity over Time is Associated with Out-of-Hospital Cardiac Arrest Outcomes. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions.
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  Beger S, Sutter J, Hu C, Spaite DW, Silver A, McDannold R, Mullins M, Vadeboncoeur TF, Bobrow BJ. Decline in Chest Compression Release Velocity over Time is Associated with Out-of-Hospital Cardiac Arrest Outcomes. Circulation 2016;133
• Dameff, C. J., Tully, J., Panczyk, M., Kannan, V., Vadeboncoeur, T. F., Spaite, D. W., & Bobrow, B. J. (2016, Jan). 9-1-1 Caller descriptions of Abnormal Breathing During Out-of-Hospital Cardiac Arrest. Prehospital Emergency Care.
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  Dameff CJ, Tully J, Panczyk M, Kannan V, Vadeboncoeur T, Spaite DW, Bobrow BJ: 9-1-1 Caller descriptions of Abnormal Breathing During Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2016;20(1):147.
• De Maio, V., Coyle, D., Vaillancourt, C., Wells, G. A., Spaite, D. W., Nesbitt, L., & Stiell, I. G. (2016, February). Predicting the Maximal Effect of Public Access Defibrillation: Why Most Public Access Defibrillation Programs Will Not Save Lives. uOttawa Digital Repository. http://www.ruor.uottawa.ca/handle/10393/34276
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  For the OPALS Study Group.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamagru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2016, Spring). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Gaither JB, Chikani V, Spaite DW, Smith JJ, Curry M, Mhayamaguru M, Barnhart B, Adelson PD, Viscusi C, Denninghoff KR, Bobrow B: Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Prehospital Emerg Care 2016;20(1):141
• Gaither, J. B., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Spaite, D. W. (2016, Spring). Age-Related Risk of Death in Patients With Major TBI: Implications for Trauma Triage Guidelines.. Prehospital Emergency Care.
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  Gaither JB, Hu C, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, Adelson PD, Viscusi C, Denninghoff KR, Spaite DW: Age-Related Risk of Death in Patients With Major TBI: Implications for Trauma Triage Guidelines. Prehospital Emerg Care 2016;20(1):164.
• Hu, C., Spaite, D. W., Silver, A., Gaither, J. B., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2016, December). Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Circulation.
• Hu, C., Spaite, D. W., Silver, A., Gaither, J. B., McDannold, R., Mullins, M., Vadeboncoeur, T. F., & Bobrow, B. J. (2016, Nov). Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Circulation.
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  Hu C, Spaite D, Silver A, Gaither J, McDannold R, Mullins M, Vadeboncoeur T, Bobrow B. Differential Correlation of ETCO2 and CPR Quality Between Out-of-Hospital Arrests of Cardiac and Respiratory Etiology. Circulation 2016;133
• Hu, C., Spaite, D. W., Vadeboncoeur, T. F., Hypes, C. D., Murphy, R. A., Silver, A., & Bobrow, B. J. (2016, Jan). ETC02 Alone is Inadequate to Verify CPR Quality. Prehospital Emergency Care.
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  Hu C, Spaite DW, Vadeboncoeur T, Hypes C, Murphy RA, Silver A, Bobrow BJ: ETC02 Alone is Inadequate to Verify CPR Quality. Prehospital Emerg Care 2016;20(1):141-142.
• Irisawa, T., Vadeboncoeur, T. F., Hypes, C. D., McDannold, R., Mullins, M., Silver, A., Spaite, D. W., & Bobrow, B. J. (2016, Jan). Maintaining High Quality CPR With an Integrated Manual/Mechanical Resuscitation Protocol. Prehospital Emergency Care.
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  Irisawa T, Vadeboncoeur T, Hypes C, McDannold R, Mullins M, Silver A, Spaite DW, Bobrow BJ: Maintaining High Quality CPR With an Integrated Manual/Mechanical Resuscitation Protocol. Prehospital Emerg Care 2016;20(1):141-142.
• McDannold, R., Glenn, M., Tobin, J., Venuti, M., Silver, A., Spaite, D. W., & Bobrow, B. J. (2016, Jan). Prehospital Vital Sign Monitoring and Traumatic Brain Injury: What We Don’t See Could Kill You. Prehospital Emergency Care.
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  McDannold R, Glenn M, Tobin J, Venuti M, Silver A, Spaite D, Bobrow B: Prehospital Vital Sign Monitoring and Traumatic Brain Injury: What We Don’t See Could Kill You. Prehospital Emerg Care 2016;20(1):172.
• Nuno, T., Bobrow, B. J., Rogge-Miller, K. A., Panczyk, M., Esparza, M., Martinez, R. A., Mullins, T., & Spaite, D. W. (2016, Jan). Disparities in Utilization of 9-1-1 for Out-of-Hospital Cardiac Arrests Among Spanish Speaking Callers. Prehospital Emergency Care.
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  Nuno T, Bobrow BJ, Rogge-Miller KA, Panczyk M, Esparza M, Martinez R, Mullins T, Spaite DW: Disparities in Utilization of 9-1-1 for Out-of-Hospital Cardiac Arrests Among Spanish Speaking Callers. Prehospital Emerg Care 2016;20(1):146-147.
• Panczyk, M., Sutter, J., Langlais, B., Hu, C., Vadeboncoeur, T. F., Mullins, T., Spaite, D. W., & Bobrow, B. J. (2016, Nov). Telephone CPR is Independently Associated with an Increase in Initial Shockable Rhythms in Patients with Out-of-Hospital Cardiac Arrest. Circulation.
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  Panczyk M, Sutter J, Langlais B, Hu C, Vadeboncoeur TF, Mullins T, Spaite DW, Bobrow BJ. Telephone CPR is Independently Associated with an Increase in Initial Shockable Rhythms in Patients with Out-of-Hospital Cardiac Arrest. Circulation 2016;133
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherill, D., & Bobrow, B. J. (2016, Jan). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Vatsal C, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation 2016;A13835
• Spaite, D. W., Chengcheng, H., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Martinez, R. A., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2016, Jan). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Sherrill D, Chikani V, Barnhart B, Gaither JB, Denninghoff KR, Adelson PD, Viscusi C, Mullins T, Stolz U. Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study. Prehospital Emerg Care 2016;20(1):140-141.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. (2016, Nov). Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Adelson PD, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. Circulation 2016;A15910
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Viscusi, C. D., Mullins, T., Martinez, R. A., & Adelson, P. D. (2016, Jan). Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu Chengcheng, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, Gaither JB, Denninghoff KR, Viscusi C, Mullins T, Martinez R, Adelson PD. Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2016;20(1):137.
• Vadeboncoeur, T. F., Chikani, V., Spaite, D. W., Hu, C., Mullins, M., & Bobrow, B. J. (2016, Nov). Association between Coronary Angiography With or Without Percutaneous Coronary Intervention and Outcomes after Out-of-Hospital Cardiac Arrest. Circulation.
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  Vadeboncoeur TF, Chikani V, Spaite DW, Hu C, Mullins M, Bobrow BJ. Association between Coronary Angiography With or Without Percutaneous Coronary Intervention and Outcomes after Out-of-Hospital Cardiac Arrest. Circulation 2016;133
• Bobrow, B. J., Panczyk, M., Stolz, U., Vadeboncoeur, T. F., Sutter, J., Langlais, B., & Spaite, D. W. (2015, Jan). Statewide Implementation of a Standardized Pre-Arrival Telephone CPR Program is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest. Prehospital Emergency Care.
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  Bobrow B, Panczyk M, Stolz U, Vadeboncoeur T, Sutter J, Langlais B, Spaite D: Statewide Implementation of a Standardized Pre-Arrival Telephone CPR Program is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2015;19(1):140-141
• Bobrow, B. J., Panczyk, M., Stolz, U., Vadeboncoeur, T., Sutter, J., Langlais, B., & Spaite, D. W. (2015, Spring). Statewide Implementation of a Standardized Pre-Arrival Telephone CPR Program is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest. Prehospital Emergency Care.
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  Bobrow B, Panczyk M, Stolz U, Vadeboncoeur T, Sutter J, Langlais B, Spaite D: Statewide Implementation of a Standardized Pre-Arrival Telephone CPR Program is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2015;19(1):140-141
• Bobrow, B. J., Spaite, D. W., Murphy, R. A., Silver, A., McDannold, R., Mullins, M., Stolz, U., & Kaufman, C. (2015, Jan). The Association Between ETC02 and Chest Compression Depth During Prehospital Resuscitation: ETCO2 Alone is Inadequate to Assess CPR Quality. Prehospital Emergency Care.
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  Bobrow B, Spaite D, Murphy RA, Silver A, McDannold R, Mullins M, Stolz U, Kaufman C. The Association Between ETC02 and Chest Compression Depth During Prehospital Resuscitation: ETCO2 Alone is Inadequate to Assess CPR Quality. Prehospital Emerg Care 2015;19(1):144.
• Gaither, J. B., Bradshaw, H. R., Smith, J. J., Waters, K. E., & Spaite, D. W. (2015, Jan). Development of a Novel Course to Integrate EMS Fellow, Emergency Medicine Resident, and Undergraduate Education in EMS Systems Organization and Deployment. Prehospital Emergency Care.
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  Gaither JB, Bradshaw HR, Smith JJ, Waters K, Spaite DW: Development of a Novel Course to Integrate EMS Fellow, Emergency Medicine Resident, and Undergraduate Education in EMS Systems Organization and Deployment. Prehospital Emerg Care 2015;19(2):340.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2015, November). Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. Circulation.
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  Gaither JB, Chikani V, Spaite DW, Smith JJ, Curry M, Mhayamaguru M, Barnhart B, Adelson PD, Viscusi C, Denninghoff KR, Bobrow B; Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. Circulation 2015;132
• Gaither, J. B., Chikani, V., Spaite, D. W., Stolz, U., Garrison, S., Smith, J., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2015, Jan). Association Between Initial Trauma Center Body Temperature and Mortality from Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Gaither JB, Chikani V, Spaite DW, Stolz U, Garrison S, Smith J, Barnhart B, Adelson PD, Viscusi C, Denninghoff K, Bobrow BJ: Association Between Initial Trauma Center Body Temperature and Mortality from Major Traumatic Brain Injury. Prehospital Emerg Care 2015;19(1):165.
• Gaither, J. B., Duncan, M., Draper, S., Spaite, D. W., Smith, J., Rice, A., Mhayamaguru, K., Tolson, J. P., Janajreh, Y. M., Enriquez, N. A., Gaither, J. B., Duncan, M., Draper, S., Spaite, D. W., Smith, J., Rice, A., Mhayamaguru, K., Tolson, J. P., Janajreh, Y. M., & Enriquez, N. A. (2019, Aug). Case Series Illustrating Adverse Reactions to Prehospital Administration of Low Dose Ketamine for Pain Control. Prehospital Emergency Care.
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  Enriquez NA, Janajreh YM, Tolson JP, Mhayamaguru KM, Rice AD, Smith JJ, Spaite DW, Draper S, Duncan D, Gaither JB. Case Series Illustrating Adverse Reactions to Prehospital Administration of Low Dose Ketamine for Pain Control. Prehospital Emerg Care 2019
• Hu, C., Spaite, D. W., Vadeboncoeur, T. F., Hypes, C., Murphy, R. A., Silver, A., & Bobrow, B. J. (2015, Nov). ETCO2 alone is inadequate to verify CPR quality. Circulation.
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  Hu C, Spaite D, Vadeboncoeur T, Hypes C, Murphy RA, Silver A, Bobrow B: ETCO2 alone is inadequate to verify CPR quality. Circulation 2015;132:A18435.
• Hypes, C. D., Spaite, D. W., Vadeboncoeur, T. F., Murphy, R. A., Hu, C., McDannold, R., Silver, A., & Bobrow, B. J. (2015, November). Elevated PETCO2 During Cardiac Resuscitation Without Return of Spontaneous Circulation. Resuscitation Science Symposium of the American Heart Association.
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  Hypes C, Spaite D, Vadeboncoeur T, Murphy RA, Hu C, McDannold R, Silver A, Bobrow B: Elevated petco2 during cardiac resuscitation without return of spontaneous circulation. Circulation 2015;132:A19572
• Irisawa, T., Stolz, U., Spaite, D. W., Silver, A., Vadeboncoeur, T. F., & Bobrow, B. J. (2015, Jan). Chest Compression Release Velocity Declines over Time during CPR.. Prehospital Emergency Care.
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  Irisawa T, Stolz U, Spaite D, Silver A, Vadeboncoeur T, Bobrow B: Chest Compression Release Velocity Declines over Time during CPR. Prehospital Emerg Care 2015;19(1):144-145.
• Langlais, B., Panczyk, M., Irisawa, T., Ryoo, H. W., Jaber, J., Spaite, D. W., & Bobrow, B. J. (2015, Jan). Barriers to Effective Bystander-Initiated CPR in Out-of-Hospital Cardiac Arrest.. Prehospital Emergency Care.
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  Langlais B, Panczyk M, Irisawa T, Ryoo HW, Jaber J, Spaite D, Bobrow B: Barriers to Effective Bystander-Initiated CPR in Out-of-Hospital Cardiac Arrest. Prehospital Emerg Care 2015;19(1):170.
• Spaite, D. W., Viscusi, C. D., Denninghoff, K. R., Barnhart, B. J., Stolz, U., Hu, C., Gaither, J. B., Bobrow, B. J., Sherrill, D. L., Chikani, V., Adelson, P. D., & Mullins, T. (2015, November). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study.. Circulation.
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  Spaite DW, Hu Chengcheng, Bobrow BJ, Sherrill D, Chikani V, Barnhart B, Martinez R, Gaither JB, Denninghoff KR, Adelson PD, Viscusi C, Mullins T, Stolz U: Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. Circulation 2015;132:A14938.
• Spaite, D. W., Waters, K. E., Smith, J. J., Bradshaw, H. R., & Gaither, J. B. (2015, Spring). Development of a Novel Course to Integrate EMS Fellow, Emergency Medicine Resident, and Undergraduate Education in EMS Systems Organization and Deployment. Prehospital Emergency Care.
• Stolz, U., Irisawa, T., Ryoo, H. W., Silver, A., McDannold, R., Jaber, J., Spaite, D. W., & Bobrow, B. J. (2015, Jan). Time in CPR is Significantly Related to CPR Quality and Survival.. Prehospital Emergency Care.
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  Stolz U, Irisawa T, Ryoo HW, Silver A, McDannold R, Jaber J, Spaite D, Bobrow B: Time in CPR is Significantly Related to CPR Quality and Survival. Prehospital Emerg Care 2015;19(1):145
• Stolz, U., Irisawa, T., Ryoo, H. W., Silver, A., McDannold, R., Jaber, J., Spaite, D. W., & Bobrow, B. J. (2015, Spring). Time in CPR is Significantly Related to CPR Quality and Survival.. Prehospital Emergency Care.
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  Stolz U, Irisawa T, Ryoo HW, Silver A, McDannold R, Jaber J, Spaite D, Bobrow B: Time in CPR is Significantly Related to CPR Quality and Survival. Prehospital Emerg Care 2015;19(1):145
• Stolz, U., Spaite, D. W., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Humble, W. O., & Denninghoff, K. R. (2015, Jan). Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold?. Prehospital Emergency Care.
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  Stolz U, Spaite DW, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, Gaither JB, Adelson PD, Viscusi C, Mullins T, Humble W, Denninghoff KR: Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold? Prehospital Emerg Care 2015;19(1):143
• Stolz, U., Spaite, D. W., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Humble, W. O., & Denninghoff, K. R. (2015, Spring). Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold?. Prehospital Emergency Care.
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  Stolz U, Spaite DW, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, Gaither JB, Adelson PD, Viscusi C, Mullins T, Humble W, Denninghoff KR: Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold? Prehospital Emerg Care 2015;19(1):143
• Sutter, J., Langlais, B., Dameff, C., Tully, J., Panczyk, M., Chikani, V., Vadeboncoeur, T. F., Spaite, D. W., & Bobrow, B. J. (2015, November). Telecommunicator CPR intervention improves recognition of cardiac arrest and time to first chest compression. American Heart Association (AHA) Resuscitation Science Symposium.
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  Sutter J, Langlais B, Dameff C, Tully J, Panczyk M, Chikani V, Vadeboncoeur TF, Spaite DW, Bobrow BJ: Telecommunicator CPR intervention improves recognition of cardiac arrest and time to first chest compression. Circulation 2015:132:A12075