title: Characteristics of out-of-hospital shock care.
abstract: OBJECTIVE
  Regionalization of care is a potential strategy for the management of shock. There are no data describing the regional distribution of patients with out-of-hospital shock. We sought to describe the incidence, demographic, clinical, and regional characteristics of patients with traumatic and nontraumatic medical shock treated by out-of-hospital emergency medical services.
  
  
  METHODS
  Descriptive study using Pennsylvania statewide emergency medical services patient care data.
  
  
  METHODS
  Commonwealth of Pennsylvania, 2006-2008.
  
  
  METHODS
  Adult (age ≥ 18 yrs) noncardiac arrest patients with shock, defined as initial systolic blood pressure ≤ 80 mm Hg.
  
  
  METHODS
  None.
  
  
  RESULTS
  We compared patient characteristics, demographics, emergency medical services treatment, and regional differences between traumatic and nontraumatic medical shock. Of 3,327,306 adult nonarrest patients, 42,941 (1.29%; 95% confidence interval, 1.28% to 1.30%) had shock in the field, including 39,424 with medical shock and 3,517 with traumatic shock. Patients with medical shock were more likely to be older, female, and treated by rural emergency medical services agencies and experienced longer transport times. County-level annual shock rates varied for medical (median, 99; interquartile range, 44-273; range, 5-1634) and traumatic (median, seven; interquartile range, 3-18; range, 0-300) cases. Per-capita shock rates varied for medical (median, 105 per 100,000 population; interquartile range, 83-128; range, 37-263) and traumatic (median, seven per 100,000 population; interquartile range, 5-10; range, 0-39) cases. The correlation between county-level total annual medical and traumatic shock rates was strong (ρ = .80).
  
  
  CONCLUSIONS
  While sharing similar regional distributions, key differences exist between emergency medical services patients with traumatic and nontraumatic shock. These differences identify opportunities for and barriers to regionalizing emergency medical services care of patients with shock.
authors.affiliation: Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. hwang@uabmc.edu
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012189:Retrospective Studies; D012737:Sex Factors; D012769:Shock / Q000628:therapy*; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult