| dc.description.abstract | "Orange County Emergency Services (OCES) department is headquartered in Hillsborough, North Carolina. The department provides 9-1-1 service Emergency Medical Service (EMS) to about 146,000 residents.OCES responded to 16,500 emergency calls in FY 2019-20, attended to 11,865 patients, and transported 9,314 to medical facilities in Orange and neighboring counties. OCES conducts regular quality assurance (QA) reviews on all PCRs. The QAs are a tool used at OCES to provide insight into paramedic competence and examine patient outcomes. OCES identified differences between documented first impression diagnostic operational data on the prehospital patient record (PCR) when compared to the emergency department admission record entered by physicians at hospital admissions at UNC facilities. The initial QA findings by OCES are reflected in a wide range of EMS responses from respiratory complaints to abdominal pain. This type of variation can potentially lead to poor patient outcomes resulting from inaccurate clinical diagnosis in the field by paramedics. A root cause for this difference with first medical impressions between the two groups of practitioners has not been identified. A review of more than 12,000 EMS medical records identified potential causes for the variations. Changes to how paramedics document first impressions are recommended, in addition to improving con-ed opportunities and how paramedics work with physicians in the emergency department.
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