Secondary Public Safety Answering Points Delay the Response to out of Hospital Cardiac Arrest Bruce J. Moeller, Angus M. Jameson, Johnathon Elkes, Michael Lozano Prehospital Emergency Care, 2024 Background: National guidelines recommend that high-performing systems process 9-1-1 calls within 60 s and deliver the first telecommunicator cardiopulmonary resuscitation compression within 90 s. The inability of systems employing secondary public safety answering points (PSAPs) to capture the call arrival timestamp at the primary PSAP is a challenge in out-of-hospital cardiac arrest response time research.Objective: We sought to measure the interval from call receipt at primary PSAPs to call answer at secondary PSAPs in metropolitan areas.Methods: This was a retrospective observational study evaluating 9-1-1 call transfers between PSAPs serving large urban populations. Call transfer records were extracted from the 9-1-1 telephony systems at the primary and secondary PSAPs covering seven metropolitan EMS systems. For each transferred call, we obtained the call arrival timestamp at both the primary and secondary PSAPs. The primary outcome was the interval between these two times. Results were compared to a national standard of 90% of calls forwarded within 30 s of receipt.Results: Data collected at seven metropolitan EMS agencies from January 1, 2021, through June 30, 2021, yielded 299,679 records for evaluation. The median interval required to transfer a 9-1-1 caller from primary to secondary PSAPs was 41 s (IQR 31, 59), and 86 s at the 90th percentile. The 90th percentile performance level at individual agencies ranged from 63 s to 117 s.Conclusions: The primary to secondary PSAP transfer interval lengths observed in this study preclude these EMS agencies from meeting out-of-hospital cardiac arrest performance recommendations at the 90% percentile performance level.
Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review Andra M. Farcas, Anjni P. Joiner, Jordan S. Rudman, Karthik Ramesh, Gilberto Torres, Remle P. Crowe, Travis Curtis, Rickquel Tripp, Karen Bowers, Megan von Isenburg, Robert Logan, Lauren Coaxum, Gilberto Salazar, Michael Lozano, David Page, Ameera Haamid Prehospital Emergency Care, 2023 BACKGROUND: Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE: We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS: We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS: One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS: Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.
Observed survival benefit of mild therapeutic hypothermia reanalysing the Circulation Improving Resuscitation Care trial Alexander Nürnberger, Harald Herkner, Fritz Sterz, Jan‐Aage Olsen, Michael Lozano, Pierre M. van Grunsven, E. Brooke Lerner, David Persse, Reinhard Malzer, Marc A. Brouwer, Mark Westfall, Chris M. Souders, David T. Travis, Ulrich R. Herken, Lars Wik European Journal of Clinical Investigation, 2017 BackgroundMild therapeutic hypothermia is argued being beneficial for outcome after cardiac arrest.Materials and methodsRetrospective analysis of Circulation Improving Resuscitation Care (CIRC) trial data to assess if therapeutic cooling to 33 ± 1 °C core temperature had an association with survival. Of 4231 adult, out‐of‐hospital cardiac arrests of presumed cardiac origin initially enrolled, eligibility criteria for therapeutic hypothermia were met by 1812. Logistic regression was undertaken in a stepwise fashion to account for the impact on outcome of each significant difference and for the variable of interest between the groups.ResultsOut‐of‐ and in‐hospital cooled were 263 (15%), only after admission cooled were 230 (13%) and not cooled were 357 (20%) patients. The group cooled out of‐ and in hospital had 98 (37%) survivors as compared to the groups cooled in hospital only [80 (35%)] and of those not cooled [68 (19%)]. After adjusting for known covariates (sex, age, witnessed cardiac arrest, no‐ and low‐flow time, shockable initial rhythm, random allocation, bystander cardiopulmonary resuscitation and percutaneous coronary intervention), the odds ratio for survival comparing no cooling to out‐of‐ plus in‐hospital cooling was 0·53 [95% confidence interval (CI): 0·46–0·61, P < 0·001], and comparing to in‐hospital cooling only was 0·67 (95% CI: 0·50–0·89, P = 0·006).ConclusionMild therapeutic hypothermia initiated out of hospital and/or in hospital was associated with improved survival within this secondary analysis of the CIRC cohort compared to no therapeutic hypothermia.
Why Diversity and Inclusion Are Critical to the American College of Emergency Physicians' Future Success Rebecca Bollinger Parker, Steven J. Stack, Sandra M. Schneider, Steven H. Bowman, Kerryann B. Broderick, N. Adam Brown, C. Savoy Brummer, Michelle Byers, Vidya Eswaran, Katherine L. Heilpern, Sanford H. Herman, Sheryl L. Heron, Hamad Husainy, Tiffany D. Jackson, Jay Kaplan, Dara Kass, Kevin Klauer, Linda L. Lawrence, Michael Lozano, Abhi Mehrotra, Sonja Montgomery, Aasim I. Padela, Rebecca Parker, Sanjay Pattani, Julie A. Rispoli, Hala Sabry, Cynthia Singh, Java Tunson, Dean Wilkerson, Carole Wollard Annals of Emergency Medicine, 2017
Chest compression duration influences outcome between integrated load-distributing band and manual CPR during cardiac arrest J.‐A. Olsen, E. B. Lerner, D. Persse, F. Sterz, M. Lozano, M. A. Brouwer, M. Westfall, P. M. van Grunsven, D. T. Travis, U. R. Herken, C. Brunborg, L. Wik Acta Anaesthesiologica Scandinavica, 2016 BackgroundThe Circulation Improving Resuscitation Care (CIRC) Trial found equivalent survival in adult out‐of‐hospital cardiac arrest (OHCA) patients who received integrated load‐distributing band CPR (iA‐CPR) compared to manual CPR (M‐CPR). We hypothesized that as chest compression duration increased, iA‐CPR provided a survival benefit when compared to M‐CPR.MethodsA pre‐planned secondary analysis of OHCA of presumed cardiac etiology from the randomized CIRC trial. Chest compressions duration was defined as the total number of minutes spent on compressions during resuscitation and identified from transthoracic impedance and accelerometer data recorded by the EMS defibrillator. Logistic regression was used to model the interaction between treatment and duration of chest compressions and was covariate‐adjusted for trial site, patient age, witnessed arrest, and initial shockable rhythm. Primary outcome was survival to hospital discharge.ResultsWe enrolled 4231 subjects and of those, 2012 iA‐CPR and 2002 M‐CPR had complete outcome and duration of chest compressions data. While covariate‐adjusted odds ratio for survival to hospital discharge was 1.86 in favor of iA‐CPR (95% CI 1.16–3.0), there was an interaction between duration and study arm. When this was factored into the multivariate equation, the odds ratio for survival to hospital discharge showed a significant benefit for iA‐CPR vs. M‐CPR for chest compression duration greater than 16.5 min.ConclusionAfter adjusting for compression duration and duration–treatment interaction, iA‐CPR showed a significant benefit for survival to hospital discharge vs. M‐CPR in patients with OHCA if chest compression duration was longer than 16.5 min.
Clinical evaluation of a novel intraosseous device for adults: prospective, 250-patient, multi-center trial. JEMS A Journal of Emergency Medical Services, 2005
No-fly zones: Hillsborough County defines urban grids where ground transport of trauma patients makes the most sense. JEMS A Journal of Emergency Medical Services, 2004
Derivation and validation of a clinical prediction score for ICU utilization at trauma intake M Makutonin, AV Sapre, TR Hartka, BM Lo, M Lozano Jr, M Smith, ... The American Journal of Emergency Medicine , 2026 2026
154 Derivation and Validation of a Clinical Prediction Model for ICU Utilization at Trauma Intake M Makutonin, A Sapre, T Hartka, B Lo, M Lozano, M Smith, A Meltzer, ... Annals of Emergency Medicine 86 (3), S67 , 2025 2025
142 Derivation and Validation of a Clinical Risk Score to Predict Need for Intensive Care Unit Utilization After Initial Emergency Department Evaluation of Patients With Acute … M Makutonin, T Hartka, B Lo, M Lozano, M Smith, R Heidish, B Sarani, ... Annals of Emergency Medicine 84 (4), S67 , 2024 2024
455 Analysis of Vector Change Defibrillation by Paramedics for Prehospital Refractory Ventricular Fibrillation A Kropp, K Dumas, T Smith, A Jameson, M Lozano Annals of Emergency Medicine 84 (4), S203-S204 , 2024 2024
Secondary Public Safety Answering Points Delay the Response to out of Hospital Cardiac Arrest BJ Moeller, AM Jameson, J Elkes, M Lozano Jr Prehospital emergency care 28 (1), 135-138 , 2024 2024
Disparities in emergency medical services care delivery in the United States: a scoping review AM Farcas, AP Joiner, JS Rudman, K Ramesh, G Torres, RP Crowe, ... Prehospital emergency care 27 (8), 1058-1071 , 2023 2023 Citations: 72
Survival to hospital discharge with biphasic fixed 360 joules versus 200 escalating to 360 joules defibrillation strategies in out-of-hospital cardiac arrest of presumed … JA Olsen, C Brunborg, M Steinberg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 136, 112-118 , 2019 2019 Citations: 18
Why diversity and inclusion are critical to the American College of Emergency Physicians' future success RB Parker, SJ Stack, SM Schneider, SH Bowman, KB Broderick, ... Annals of emergency medicine 69 (6), 714-717 , 2017 2017 Citations: 41
Observed survival benefit of mild therapeutic hypothermia reanalysing the Circulation Improving Resuscitation Care trial A Nürnberger, H Herkner, F Sterz, JA Olsen, M Lozano Jr, ... European Journal of Clinical Investigation 47 (6), 439-446 , 2017 2017 Citations: 26
Why do some studies find that CPR fraction is not a predictor of survival? L Wik, JA Olsen, D Persse, F Sterz, M Lozano Jr, MA Brouwer, M Westfall, ... Resuscitation 104, 59-62 , 2016 2016 Citations: 53
Defibrillation success during different phases of the mechanical chest compression cycle MT Steinberg, JA Olsen, C Brunborg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 103, 99-105 , 2016 2016 Citations: 10
Chest compression duration influences outcome between integrated load‐distributing band and manual CPR during cardiac arrest JA Olsen, EB Lerner, D Persse, F Sterz, M Lozano Jr, MA Brouwer, ... Acta Anaesthesiologica Scandinavica 60 (2), 222-229 , 2016 2016 Citations: 18
Pre-shock chest compression pause effects on termination of ventricular fibrillation/tachycardia and return of organized rhythm within mechanical and manual cardiopulmonary … JA Olsen, C Brunborg, M Steinberg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 93, 158-163 , 2015 2015 Citations: 29
Minimizing pre-shock chest compression pauses in a cardiopulmonary resuscitation cycle by performing an earlier rhythm analysis MT Steinberg, JA Olsen, C Brunborg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 87, 33-37 , 2015 2015 Citations: 26
Defibrillation During Mechanical Chest Compressions Should Be Avoided During the Downstroke Phase of the Chest Compression Cycle MT Steinberg, JA Olsen, C Brunborg, D Persse, CM Souders, M Lozano, ... Circulation 130 (suppl_2), A85-A85 , 2014 2014 Citations: 2
Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial L Wik, JA Olsen, D Persse, F Sterz, M Lozano Jr, MA Brouwer, M Westfall, ... Resuscitation 85 (6), 741-748 , 2014 2014 Citations: 461
Defibrillation during different phases of the mechanical chest compression–decompression cycle–Effects on termination of ventricular fibrillation/pulseless ventricular tachycardia JA Olsen, M Steinberg, CM Souders, C Brunborg, D Persse, F Sterz, ... Resuscitation 85, S8-S9 , 2014 2014
Integrated autopulse CPR improves survival from out-of hospital cardiac arrests compared to manual CPR after controlling for EMS response times L Wik, JA Olsen, D Persse, F Sterz, M Lozano, MA Brouwer, M Westfall, ... Circulation 128 (suppl_22), A168-A168 , 2013 2013 Citations: 1
During a Cardiopulmonary Resuscitation Cycle it is Necessary to Re-verify a Shockable Rhythm Prior to Defibrillation Attempts MT Steinberg, JA Olsen, C Brunborg, D Persse, F Sterz, M Lozano, ... Circulation 128 (suppl_22), A162-A162 , 2013 2013
Duration of Pre-shock Compression Pause Does Not Affect Defibrillation Success in Out-of-Hospital Cardiac Arrest Treated With Either Manual or Load-Distributing Band Compressions JA Olsen, CM Souders, MT Steinberg, C Brunborg, D Persse, F Sterz, ... Circulation 128 (suppl_22), A155-A155 , 2013 2013
MOST CITED SCHOLAR PUBLICATIONS
Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial L Wik, JA Olsen, D Persse, F Sterz, M Lozano Jr, MA Brouwer, M Westfall, ... Resuscitation 85 (6), 741-748 , 2014 2014 Citations: 461
Clinical evaluation of a novel intraosseous device for adults: prospective, 250-patient, multi-center trial. J Davidoff, R Fowler, D Gordon, G Klein, J Kovar, M Lozano, J Potkya, ... JEMS: a journal of emergency medical services 30 (10), suppl 20-23 , 2005 2005 Citations: 152
“Abnormal” electrocardiograms in patients with cocaine-associated chest pain are due to “normal” variants JE Hollander, M Lozano, P Fairweather, E Goldstein, P Gennis, ... The Journal of emergency medicine 12 (2), 199-205 , 1994 1994 Citations: 82
Disparities in emergency medical services care delivery in the United States: a scoping review AM Farcas, AP Joiner, JS Rudman, K Ramesh, G Torres, RP Crowe, ... Prehospital emergency care 27 (8), 1058-1071 , 2023 2023 Citations: 72
Design of the Circulation Improving Resuscitation Care (CIRC) Trial: a new state of the art design for out-of-hospital cardiac arrest research EB Lerner, D Persse, CM Souders, F Sterz, R Malzer, M Lozano Jr, ... Resuscitation 82 (3), 294-299 , 2011 2011 Citations: 72
Why do some studies find that CPR fraction is not a predictor of survival? L Wik, JA Olsen, D Persse, F Sterz, M Lozano Jr, MA Brouwer, M Westfall, ... Resuscitation 104, 59-62 , 2016 2016 Citations: 53
Why diversity and inclusion are critical to the American College of Emergency Physicians' future success RB Parker, SJ Stack, SM Schneider, SH Bowman, KB Broderick, ... Annals of emergency medicine 69 (6), 714-717 , 2017 2017 Citations: 41
Effect of adenosine on the management of supraventricular tachycardia by urban paramedics M Lozano Jr, BA McIntosh, LM Giordano Annals of emergency medicine 26 (6), 691-696 , 1995 1995 Citations: 31
Variations in the electrocardiograms of young adults: are revised criteria for thrombolysis needed? JE Hollander, M Lozano Jr, E Goldstein, P Gennis, W Slater, ... Academic Emergency Medicine 1 (2), 94-102 , 1994 1994 Citations: 30
Pre-shock chest compression pause effects on termination of ventricular fibrillation/tachycardia and return of organized rhythm within mechanical and manual cardiopulmonary … JA Olsen, C Brunborg, M Steinberg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 93, 158-163 , 2015 2015 Citations: 29
Observed survival benefit of mild therapeutic hypothermia reanalysing the Circulation Improving Resuscitation Care trial A Nürnberger, H Herkner, F Sterz, JA Olsen, M Lozano Jr, ... European Journal of Clinical Investigation 47 (6), 439-446 , 2017 2017 Citations: 26
Minimizing pre-shock chest compression pauses in a cardiopulmonary resuscitation cycle by performing an earlier rhythm analysis MT Steinberg, JA Olsen, C Brunborg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 87, 33-37 , 2015 2015 Citations: 26
Survival to hospital discharge with biphasic fixed 360 joules versus 200 escalating to 360 joules defibrillation strategies in out-of-hospital cardiac arrest of presumed … JA Olsen, C Brunborg, M Steinberg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 136, 112-118 , 2019 2019 Citations: 18
Chest compression duration influences outcome between integrated load‐distributing band and manual CPR during cardiac arrest JA Olsen, EB Lerner, D Persse, F Sterz, M Lozano Jr, MA Brouwer, ... Acta Anaesthesiologica Scandinavica 60 (2), 222-229 , 2016 2016 Citations: 18
Defibrillation success during different phases of the mechanical chest compression cycle MT Steinberg, JA Olsen, C Brunborg, D Persse, F Sterz, M Lozano Jr, ... Resuscitation 103, 99-105 , 2016 2016 Citations: 10
Comparison of Survival to Hospital Discharge between Integrated AutoPulse-CPR and Manual-CPR during out-of-hospital cardiac arrest of presumed cardiac orgin: The Circulation … L Wik, J Olsen, D Persse, F Sterez, M Lozano, MA Brouwer, M Westfall, ... Proceedings of Amercian Heart Association Scientific Session, 12-16 , 2011 2011 Citations: 6
Defibrillation During Mechanical Chest Compressions Should Be Avoided During the Downstroke Phase of the Chest Compression Cycle MT Steinberg, JA Olsen, C Brunborg, D Persse, CM Souders, M Lozano, ... Circulation 130 (suppl_2), A85-A85 , 2014 2014 Citations: 2
The impact of hypothermia treatment on survival to hospital discharge for patients with out-of-hospital cardiac arrest in the circulation improving resuscitation care (CIRC) trial L Wik, JA Olsen, D Persse, F Sterz, M Lozano, MA Brouwer, M Westfall, ... Circulation 126 (suppl_21), A159-A159 , 2012 2012 Citations: 2
The impact of CPR duration on survival to hospital discharge between integrated AutoPulse-CPR and manual-CPR during out-of-hospital cardiac arrest of presumed cardiac origin L Wik, JÅ Olsen, D Persse, F Sterz, M Lozano, MA Brouwer, M Westfall, ... Resuscitation 83, e17 , 2012 2012 Citations: 2
No-fly zones: Hillsborough County defines urban grids where ground transport of trauma patients makes the most sense. DT Travis, M Lozano Jr JEMS: a Journal of Emergency Medical Services 29 (5), 116-8, 120, 123 , 2004 2004 Citations: 2