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{ "pk": 11363, "title": "Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care", "subtitle": null, "abstract": "Introduction: \nIn the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.\nMethods:\n We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. \nResults:\n Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. \nConclusion:\n Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "altered mental status" }, { "word": "Altered Level of Consciousness" }, { "word": "Glasgow Coma Scale" }, { "word": "emergency medical services" }, { "word": "Clinical Protocols" }, { "word": "Evidence-based" }, { "word": "prehospital care" } ], "section": "Disaster Medicine/ Emergency Medical Services", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6315b2wb", "frozenauthors": [ { "first_name": "Ashley", "middle_name": "", "last_name": "Sanello", "name_suffix": "", "institution": "Los Angeles County Emergency Medical Services (EMS) Agency, Santa Fe Springs, California\nHarbor UCLA, Department of Emergency Medicine, Torrance, California", "department": "None" }, { "first_name": "Marianne", "middle_name": "", "last_name": "Gausche-Hill", "name_suffix": "", "institution": "Los Angeles County Emergency Medical Services (EMS) Agency, Santa Fe Springs, California\nHarbor UCLA, Department of Emergency Medicine, Torrance, California\nDavid Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California\nEMS Medical Directors Association of California", "department": "None" }, { "first_name": "William", "middle_name": "", "last_name": "Mulkerin", "name_suffix": "", "institution": "Stanford University, Department of Emergency Medicine, Stanford, California", "department": "None" }, { "first_name": "Karl", "middle_name": "A.", "last_name": "Sporer", "name_suffix": "", "institution": "University of California, San Francisco, Department of Emergency Medicine, San Francisco, California\nEMS Medical Directors Association of California", "department": "None" }, { "first_name": "John", "middle_name": "F.", "last_name": "Brown", "name_suffix": "", "institution": "University of California, San Francisco, Department of Emergency Medicine, San Francisco, California\nEMS Medical Directors Association of California", "department": "None" }, { "first_name": "Kristi", "middle_name": "L.", "last_name": "Koenig", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nCounty of San Diego, Health & Human Services Agency, Emergency Medical Services, San Diego, California\nUniversity of California, Irvine, Department of Emergency Medicine, Orange, California", "department": "None" }, { "first_name": "Eric", "middle_name": "M.", "last_name": "Rudnick", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nNorCal EMS Agency, Redding, California", "department": "None" }, { "first_name": "Angelo", "middle_name": "A.", "last_name": "Salvucci", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nVentura County EMS Agency, Oxnard, California", "department": "None" }, { "first_name": "Gregory", "middle_name": "H.", "last_name": "Gilbert", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nStanford University, Department of Emergency Medicine, Stanford, California", "department": "None" } ], "date_submitted": "2017-09-28T06:00:16Z", "date_accepted": "2017-09-28T06:00:16Z", "date_published": "2018-03-08T16:03:35Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11363/galley/6162/download/" } ] }