Assessment of the quality improvement of prehospital emergency care in Sweden

The optimal competence level of personnel involved in prehospital emergency care is a matter for discussion. In Sweden a national quality improvement process has been initiated including strict regulation of the authorization of ambulance personnel to administer drugs and increased involvement of registered nurses. The aim of the present study was to assess from a national survey the present status of the ongoing quality improvement process in prehospital emergency care in Sweden. A questionnaire, detailing organizational, staffing, competence and functional aspects, was sent to all medical directors of prehospital EMS. The response frequency was 87.5%. Variations in the local organization of the prehospital care were observed. Only a limited number (20%) of the districts organized the ambulance services according to the competence level of the personnel. It was found that the competence level of the personnel involved in prehospital emergency care had improved considerably compared with the situation 5 years ago. A majority of the ambulancemen had increased their competence level by completing nurse assistant training and more registered nurses had been employed. The changes in the competence level and organization of the ambulance services and prehospital emergency care were considered to have had moderate (38.5%) or great (51.9%) impact on the quality of the services during the past 5 years. The effect was reported by 53.2% of the directors to be objectively verified from review of ambulance records, regular proficiency tests, patient survival data (cardiopulmonary resuscitation), and analyses of computer-based records. It is concluded that the present study clearly shows that quality improvement process initiated by the Swedish authorities has resulted in a considerable improvement of prehospital emergency care in Sweden during the past few years.

Military and civilian emergency aeromedical services: common goals and different approaches

Military and civilian organizations in the U.S. operate separate but parallel emergency aeromedical services. Despite common origins, military and civilian approaches and methods have diverged. This article compares and contrasts the capabilities, priorities, safety, equipment, training and personnel of the largest military service, the U.S. Army, to civilian rotary wing (helicopter) emergency aeromedical programs. The different successes of military and civilian emergency aeromedical programs can be considered for use to improve the services of each. In general, Army programs operate larger aircraft and utilize two pilots per aircraft. Safety is a high priority and the Army aeromedical safety record is excellent. The Army also places a high degree of emphasis on crashworthiness and protective gear for the crew. Most civilian air Emergency Medical Service (EMS) programs operate small to moderate-sized aircraft flying with a single pilot. The recent safety record has improved dramatically. Civilian programs may add to their safety by considering two pilots and incorporating the crashworthy and protective advancements made by the military. Civilian programs fly with two highly trained medical technicians, nurses or physicians, equipped with state-of-the-art medical equipment. Army helicopters fly with one lesser-trained medical crewmember and less equipment. Improved combat casualty care and battlefield survival may be possible by increasing both the number and training of the medical attendants on Army aircraft.

Mission, staffing, and budget data of flight programs in the United States

INTRODUCTION

Manage care and other health care reform initiatives have forced all hospitals to evaluate their work processes. In this era of cost containment, many flight programs are examining the structure of their programs to determined whether they are functioning in an efficient, cost-effective fashion.

METHODS

A survey was sent to the chief flight nurse of 240 flight programs in the United States.

RESULTS

Eighty-five programs (35.4%) responded. Data were collected on demographics, management structure, mission information, staffing issues, and budgets. Results in each program varied widely.

CONCLUSION

Benchmark data are available against which programs can compare themselves. Such comparisons may allow the discovery of opportunities to enhance program efficiency and cost-effectiveness.

Comparison of two methods of transporting paramedics to cardiac arrests outside hospital

OBJECTIVE

To compare the deployment of paramedics in a separate rapid response unit with their deployment in a standard emergency ambulance.

DESIGN

A one year period of each deployment.

SETTING

Throughout the community in some parts of West Yorkshire.

PARTICIPANTS

All patients receiving resuscitation for cardiac arrest by paramedics.

INTERVENTIONS

Using the same group of paramedics and central control, 12 months with the paramedics deployed in separate cars in addition to the standard ambulances (period 1) were followed by another 12 months when they were deployed as one crew member of a standard emergency ambulance (period 2).

MAIN OUTCOME MEASURES

Number of arrests attended, number of patients in ventricular fibrillation at paramedic arrival, response times, survival to leave hospital.

RESULTS

In period 1, 580 arrests were attended with 31 survivors. In period 2, 462 arrests resulted in 25 survivors. The mean response time was shorter in period 1 (6.24 versus 6.60 min, Cl--0.01-0.73 min). In period 1, 217 patients were found in ventricular fibrillation (23 survivors): In period 2, 141 patients were found in ventricular fibrillation (11 survivors).

CONCLUSION

Separating paramedics from the standard emergency ambulances increases the number of survivors of cardiac arrest but the difference may not be sufficiently large to justify the additional expenditure.

Driving forward

A new management structure, new equipment and technology are changing the culture of the London Ambulance Service and enabling it to meet the challenges of the 90s. David Lloyd describes how.

EMS offshore. A new horizon for paramedics

The difficulty in getting medical aid to offshore drilling platforms can be a source of life-threatening delays. Recently, some companies have charted new waters by actually stationing EMS crews on their rigs.

Burning the EMS candle. EMS shifts and worker fatigue

Has coffee become your best friend? Do you sleep only in your dreams? Is your bed merely an illusion? If so, you are not alone; sleep deprivation is a fact of life for many EMS personnel. Though widely accepted, isn't it time that we question the effects of those long days and nights?