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Hayashi K, Kikuchi J, Hishinuma H, Noguchi T, Zaitsu M, Wake K. Impact of the Coronavirus Pandemic on Patients Requiring Tracheal Intubation by Helicopter Emergency Medical Services: A Retrospective, Single-Center, Observational Study. J Clin Med 2024; 13:3694. [PMID: 38999261 PMCID: PMC11242781 DOI: 10.3390/jcm13133694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The impacts of the coronavirus disease 2019 (COVID-19) pandemic on patients using helicopter emergency medical services (HEMS) regarding tracheal intubation and patient management remain unclear. Thus, we aimed to investigate this matter in Japan. Methods: In this retrospective, observational study, we analyzed 2277 patients who utilized HEMS in Tochigi Prefecture during 2018-2022. We included only patients who required tracheal intubation. We categorized patients from February 2020 to January 2022 in the pandemic group and those from February 2018 to January 2020 in the control group. We compared the interval from arrival at the scene to leaving the scene (on-scene time) and secondary variables between the two groups. Results: A total of 278 eligible patients were divided into the pandemic group (n = 127) and the control group (n = 151). The on-scene time was lower during the pandemic than that before (25.64 ± 9.19 vs. 27.83 ± 8.74 min, p = 0.043). The percentage of patients using midazolam was lower (11.8% vs. 22.5%, p = 0.02) and that of patients using rocuronium bromide was higher (29.1% vs. 6.0%, p < 0.001) during the pandemic. In contrast, the type of intervention other than tracheal intubation and the type of transportation to the hospital did not differ between the groups. Conclusions: The COVID-19 pandemic was associated with changes in the mission time of and the frequency of certain drugs administered by the HEMS. However, the type of intervention and the type of transportation did not differ. Further research is needed on changes in patient prognosis and condition due to the effects of the COVID-19 pandemic.
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Affiliation(s)
- Kentaro Hayashi
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
- Data Science Center, Jichi Medical University, Tochigi 329-0498, Japan
| | - Jin Kikuchi
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Hidekazu Hishinuma
- Department of Public Health, School of Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Takafumi Noguchi
- Department of Adult Nursing, School of Nursing, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Masayoshi Zaitsu
- Center for Research of the Aging Workforce, University of Occupational and Environmental Health, Fukuoka 807-8555, Japan
| | - Koji Wake
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan
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Qi X, Yao X, Cong X, Li S, Han M, Tao Z, Yang X, Qi X, Shi F, Wang S. Profile and risk factors in farmer injuries: a review based on Haddon matrix and 5 E's risk reduction strategy. Front Public Health 2024; 12:1322884. [PMID: 38903585 PMCID: PMC11187248 DOI: 10.3389/fpubh.2024.1322884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Farmers are considered a high-risk group for intentional and unintentional injuries. This review identified significant risk factors for agricultural injuries in farmers and explored injury prevention countermeasures based on the literature. Therefore, CiteSpace software was used to analyze the relevant literature in this field. Additionally, we identified both key risk factors and countermeasures using the Haddon matrix and the 5 E's risk reduction strategies conceptual framework, respectively. The risk factors were identified from four categories (host, agent, physical environment, and social environment) corresponding to three phases (pre-event, event, and post-event). Interventions of 5 E's risk reduction strategies including education, engineering, enforcement, economic, and emergency response have been proven effective in preventing injuries or reducing their severity. Our findings provide a comprehensive foundation and research direction for the study and prevention of injuries among farmers.
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Affiliation(s)
- Xuejie Qi
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Xue Yao
- Department of Interventional Vascular Surgery, China Rongtong Medical and Health Group Zibo 148 Hospital, Zibo, China
| | - Xianzhu Cong
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Shuang Li
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Mei Han
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Zikun Tao
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Xi Yang
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Xiao Qi
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Fuyan Shi
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
| | - Suzhen Wang
- Key Laboratory of Medicine and Health of Shandong Province, Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, China
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Lacy AJ, El-Rifai AW, Walker PW, Rief KM, Cochran CL, Ancona RM, Brywczynski JJ. Characterizing Air Medical Transport Experiences in Emergency Medicine Residency Training Programs. Air Med J 2024; 43:42-46. [PMID: 38154839 DOI: 10.1016/j.amj.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Air medical transportation (AMT) of patients plays a critical role in the prehospital care of the ill patient. Despite its importance, there is no requirement in emergency medicine training programs to have direct experience or education on the topic, and data detailing current AMT experiences across programs are limited. METHODS A survey detailing program characteristics, AMT experience characteristics, and curriculum factors relating to AMT experience was sent to all 275 credentialed emergency medicine residency training programs in the United States. Our outcomes were to describe the characteristics of AMT and non-AMT programs (proportions) and to evaluate associations (odds ratios with 95% confidence intervals) between program characteristics and 1) AMT experience opportunity and 2) level of resident participation among AMT programs. RESULTS Two hundred (73%) programs responded, with 135 of 200 (68%) offering some type of AMT experience. The majority of programs offering AMT were 3 years (113 [84%]), university based (63 [47%]), and located in small urban areas (57 [42%]). When AMT was offered, most programs reported that the overall resident participation was low (≤ 20%). Programs that did not offer shift reduction or additional pay for participation in AMT were significantly more likely to have low participation than those with incentives (odds ratio = 4.8; 95% confidence interval, 1.8-15.3). Around one third of AMT experiences allowed for direct patient care. Less than half of the responding programs reported a dedicated AMT curriculum. CONCLUSION The majority of emergency medicine residency training programs offer an AMT experience, but this experience is highly variable, and overall participation by residents is low. Given the importance of AMT in the care of emergency patients, standardization and increased access to AMT experience and education should be considered by emergency medicine training programs moving forward.
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Affiliation(s)
- Aaron J Lacy
- Department of Emergency Medicine, Washington University School of Medicine in St Louis, St Louis, MO.
| | - Ahmed W El-Rifai
- American University of Antigua College of Medicine, Osbourn, Antigua and Barbuda
| | - Philip W Walker
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Katherine M Rief
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt LifeFlight, Vanderbilt University Medical Center, Nashville, TN
| | - Caleb L Cochran
- Vanderbilt LifeFlight, Vanderbilt University Medical Center, Nashville, TN
| | - Rachel M Ancona
- Department of Emergency Medicine, Washington University School of Medicine in St Louis, St Louis, MO
| | - Jeremy J Brywczynski
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt LifeFlight, Vanderbilt University Medical Center, Nashville, TN
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Rudman JS, Fritz CL, Thomas SA, McCartin M, Price J, Blumen IJ, Thomas SH. Helicopter Emergency Medical Services Outcomes Research 1983 to 2022: Evidence Overview and Longitudinal Trends. Air Med J 2023; 42:429-435. [PMID: 37996177 DOI: 10.1016/j.amj.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) literature has been assessed in reviews focusing on various diagnoses, but there are few, if any, summaries of the entire body of HEMS outcomes evidence. Our goal was to summarize the existing research addressing patient-centered outcomes potentially accrued with HEMS. METHODS As part of the Critical Care Transport Collaborative Outcomes Research Effort, we generated the HEMS Outcomes Assessment Research Database and executed descriptive analyses of longitudinal trends from 1983 to 2022. Both indexed and gray literature sources were incorporated in the HEMS Outcomes Assessment Research Database. Studies were reviewed by at least 2 authors to select those that addressed a patient-centered outcome. Studies addressing solely HEMS logistics were excluded. Categoric analyses were executed with the Fisher exact test, and continuous variables were evaluated for normality with normal quantile plotting and a comparison of medians and 95% confidence intervals. RESULTS We found that HEMS outcomes study sample sizes increased steadily from 1983 to 2012, with the most recent decade demonstrating a marked increase in the rate of publication of HEMS outcomes studies. Most research (70.6%) addressed trauma patient outcomes, but recent decades have seen a significant increase in non-trauma studies. Recent decades have also been characterized by an increase in the production of HEMS outcomes research outside of North America and Europe. CONCLUSION This study summarizes the current state of the HEMS outcome literature. We highlight increasing contributions from worldwide researchers and increasing focus on HEMS benefits in non-trauma cases, particularly time-critical cases such as cardiac or stroke diagnoses. This provides a basis for further investigations into patient-oriented benefits potentially accrued with HEMS.
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Affiliation(s)
- Jordan S Rudman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Christie L Fritz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sarah A Thomas
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael McCartin
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - James Price
- Department of Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Norwich, United Kingdom
| | - Ira J Blumen
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
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Szabó BÁ, István Kobolka, Zádori I. Cost dynamics of helicopter emergency services: A Hungarian example. Heliyon 2023; 9:e14336. [PMID: 36938405 PMCID: PMC10018560 DOI: 10.1016/j.heliyon.2023.e14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Objectives Helicopter emergency medical services (HEMS) have been integral to healthcare systems in developed countries and are becoming more relevant in developing countries. There is extremely scarce information available regarding the typical cost structure and dynamics of HEMS operation; thus, the limitation of knowledge may limit the shapers of national healthcare policy and potential private operators in starting such a service. This study aims to present the cost dynamics of HEMS operation. Methods A systematic literature review was performed on open-source studies to obtain appropriate data. International benchmarks were found; nevertheless, as Hungarian data did not emerge, a recent investment into HEMS service was analyzed based on publicly available data from the Hungarian Air Ambulance and affiliated companies. The resulting cost base was allocated per flight hour, and a scenario was established with Western European (German) wages and salaries to challenge the aforementioned international examples. Results The average cost of operation is calculated at EUR 2488 per hour or EUR 41.5 per airborne minute based on average mission duration. This result is quite below the German example of ca. EUR 55.4 per airborne minute and even less than the US and Australian examples, but once the costing model was recalculated with German salaries, the result was extremely similar to the literature review. Nevertheless, comparable international figures need further research, as ownership structure, cost allocation method, and accounting regimes may dramatically impact the cost per airborne minute. Conclusion The cost of EUR 2488 per flight hour is a good indicator for an hourly rate of operations; however, when deciding on establishing such a service, the model needs to be adjusted for comparable salaries and foreign exchange rates. Nevertheless, if the number of flight hours can be well estimated, the yearly funding needs can be accurately determined using it.
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Peng C, Su P. Visualized analysis of research on helicopter emergency medical service. Medicine (Baltimore) 2022; 101:e30463. [PMID: 36086760 PMCID: PMC10980476 DOI: 10.1097/md.0000000000030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Numerous studies have confirmed that helicopter emergency medical services (HEMS) play a positive role in prehospital care. However, few studies have used rigorous bibliometric tools to analyze the knowledge structure and distribution of HEMS research. OBJECTIVES The purpose of this study was to use bibliometric methods to conduct a quantitative and qualitative analysis of the HEMS-related literature and to determine the research status and hotspots of HEMS research. METHODS CiteSpace was used for bibliometric analysis of the HEMS-related literature retrieved from the Web of Science database from 1989 to 2021. RESULTS A total of 1378 HEMS-related literature were included. Collaboration among countries, authors, and institutions needs to be strengthened. The topics in HEMS research have mainly focused on the effectiveness of helicopter emergency medical services for trauma patients and the comparison of transport effectiveness between helicopters and ground emergency medical services on trauma patient transport. Research over the past 10 years has mainly focused on the application of HEMS in patients with trauma, myocardial infarction, cerebral apoplexy, application of tracheal intubation technology in HEMS, and advanced airway management. In recent years, HEMS research trends have mainly included out-of-hospital cardiac arrest, and transport. CONCLUSIONS CiteSpace was used to visualize and analyze the HEMS-related literature, which visually reflected the research status and hot spots, providing references for the topic selection and development direction of HEMS research.
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Affiliation(s)
- Cheng Peng
- Xiangya School of Nursing, Central South University, Changsha Hunan, China
| | - Pan Su
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Mousavi SH, Khankeh H, Atighechian G, Yarmohammadian MH, Memarzadeh M. Challenges of prehospital aerial operations in response to earthquake hazards: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:268. [PMID: 36325237 PMCID: PMC9621378 DOI: 10.4103/jehp.jehp_1302_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/22/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUNDS Due to the severity of the earthquake, it may need immediate treatment and transfer of the injured people to advanced medical centers, as well as dispatch of the expert team and specialized health equipment to the accident-affected area. Aerial emergency is an important responsibility of the health care system in this situation. The study aimed to extract the prehospital emergency challenges of Iran aerial operations emergency in response to the earthquake. MATERIALS AND METHODS The study was qualitative content analysis with conventional approach. Sampling was done in a purposive method and data were collected through semi-structured interview. The panel involved consists of 26 health professionals in medical emergencies. Recorded interviews were transcribed into written and then conventional content analysis was used to derive coding categories directly from the text data. RESULTS Content analysis is provided 97 initial codes, 20 subcategories and 4 main categories including challenges of "response assessment," "support," "pre-hospital staff-management," and "response operation," respectively. CONCLUSIONS The results showed that the necessity to assess the affected area, staffing, and management actions, including integrated operations command and the development of a dedicated response plan, as well as the use of strategies inter-organizational coordination in the response phase to earthquake. This study also emphasized that providing standard equipment, support actions, and strengthening communication infrastructure, and updating the aerial emergency system should be considered as one of the priorities of the emergency organization of Iran to provide a desired response to the earthquake.
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Affiliation(s)
- Seyed Hossein Mousavi
- Department of Health in Disaster and Emergencies, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Khankeh
- Research Center for Emergency and Disaster Health, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Golrokh Atighechian
- Department of Health in Emergencies and Disasters, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mehrdad Memarzadeh
- Department of Surgery, School of Medicine Craniofacial and Cleft Research Center, Imam Hossein Children Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Wake K, Noguchi T, Hishinuma H, Zaitsu M, Kikuchi J, Uchida M, Hayashi K, Machida M, Houzumi H, Hoshiyama E, Takahashi K, Kobashi G, Ono K. Characteristics of patients who received helicopter emergency medical services in Japan from 2012 to 2019: a retrospective analysis of data from Tochigi Prefecture. Scand J Trauma Resusc Emerg Med 2022; 30:25. [PMID: 35410427 PMCID: PMC8996593 DOI: 10.1186/s13049-022-01012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Helicopter Emergency Medical Services (HEMS) has been in operation in Japan since 2001, allowing patients almost anywhere in the nation to receive on-scene emergency treatment from physicians. However, there is insufficient literature on the characteristics of the patients who use Japanese HEMS. Thus, this study aimed to investigate the overall characteristics of patients receiving HEMS care within a single prefecture in Japan.
Methods We retrospectively analyzed the data of 5163 patients—in Tochigi Prefecture—who received HEMS care from 2012 to 2019. Descriptive statistics were used to analyze the following aspects of care: diagnosis, severity, background characteristics, geographical and environmental variables, immediate pre-hospital intervention, transportation type, and short-term clinical outcomes. Results Among 7370 HEMS requests received during the study period, treatment was provided to 5163 patients (1.8 cases per day; 3489 men [67.6%]). Nearly 55% (n = 2856) of patients were aged above 60 years. Age peaks were observed at 0–9 years and 60–69 years. The median distance from the base hospital to the site was 26.7 km. The age-standardized rate of HEMS treatment was 30.3 patients per 100,000 people. Cases of trauma and cardiovascular diseases were the most common (65.3%). Most individuals aged 0–9 years and 60–69 years had neurological disease (seizures accounted for 80.5% of this group) and cardiovascular disease, respectively. The number of patients was similar across all four seasons. After immediate pre-hospital intervention, 81.6% of patients receiving HEMS care were transferred by the helicopter ambulance (53.4% and 28.2% to the base hospital and to other hospitals, respectively). Overall, 56.6% of patients receiving HEMS care were transferred to the base hospital, and the short-term recovery rate was above 75%. Intravenous drip and oxygen administration were the most common pre-hospital interventions (93.1% and 72.7%, respectively). Conclusions This study is the first to describe the overall characteristics of HEMS patients using comprehensive data of all HEMS patients in one prefecture in Japan. Further research using both local- and national-level data is needed to accelerate the understanding of the benefits of HEMS. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-01012-6.
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Nystøyl DS, Røislien J, Østerås Ø, Hunskaar S, Breidablik HJ, Zakariassen E. Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway. BMC Emerg Med 2020; 20:88. [PMID: 33138780 PMCID: PMC7607704 DOI: 10.1186/s12873-020-00377-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Organizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district. Methods All primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable. Results We included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001). Conclusion After relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.
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Affiliation(s)
- Dag Ståle Nystøyl
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. .,Health Services Research Group, Department of Global Public Health and Primary Care, University of Bergen, PBox 7810, 5020, Bergen, Norway.
| | - Jo Røislien
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Øyvind Østerås
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Steinar Hunskaar
- Health Services Research Group, Department of Global Public Health and Primary Care, University of Bergen, PBox 7810, 5020, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | | | - Erik Zakariassen
- Health Services Research Group, Department of Global Public Health and Primary Care, University of Bergen, PBox 7810, 5020, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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