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Malone DF, Sims A, Irwin C, Wishart D, MacQuarrie A, Bell A, Stainer MJ. Lights, Sirens, and Load: Anticipatory emergency medical treatment planning causes cognitive load during emergency response driving among paramedicine students. ACCIDENT; ANALYSIS AND PREVENTION 2024; 204:107646. [PMID: 38830295 DOI: 10.1016/j.aap.2024.107646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
Paramedics face various unconventional and secondary task demands while driving ambulances, leading to significant cognitive load, especially during lights-and-sirens responses. Previous research suggests that high cognitive load negatively affects driving performance, increasing the risk of accidents, particularly for inexperienced drivers. The current study investigated the impact of anticipatory treatment planning on cognitive load during emergency driving, as assessed through the use of a driving simulator. We recruited 28 non-paramedic participants to complete a simulated baseline drive with no task and a cognitive load manipulation using the 1-back task. We also recruited 18 paramedicine students who completed a drive while considering two cases they were travelling to: cardiac arrest and infant seizure, representing varying difficulty in required treatment. The results indicated that both cases imposed considerable cognitive load, as indicated by NASA Task Load Index responses, comparable to the 1-back task and significantly higher than driving with no load. These findings suggest that contemplating cases and treatment plans may impact the safety of novice paramedics driving ambulances for emergency response. Further research should explore the influence of experience and the presence of a second individual in the vehicle to generalise to broader emergency response driving contexts.
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Affiliation(s)
- Daniel F Malone
- School of Applied Psychology, Griffith University, Australia
| | - Alan Sims
- School of Applied Psychology, Griffith University, Australia
| | - Christopher Irwin
- School of Health Sciences and Social Work, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Darren Wishart
- School of Applied Psychology, Griffith University, Australia
| | | | - Andrew Bell
- The Royal Flying Doctor Service Western Australia, Australia
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Reimer AP, Shew J. Using NEMSIS to report annual air medical transport statistics. Air Med J 2024; 43:226-228. [PMID: 38821703 DOI: 10.1016/j.amj.2023.12.005] [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: 09/15/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 06/02/2024]
Abstract
OBJECTIVE The objective of this study was to use the National Emergency Medical Services Information System (NEMSIS) dataset to generate national air medical transport statistics. METHODS Retrospective review of the 2021 NEMSIS dataset to identify all air medical transfers, both fixed- and rotor-wing. Transfers where then subcategorized into interfacility and scene responses. Frequencies for each category were generated and reported. RESULTS A total of 317,267 air medical transfers were completed in 2021. These included 19,421 (6 %) with missing incident location code data. Of the 297,706 transfers with valid location codes, 208,689 (70%) were interfacility transfers, and 89,016 (30%) were scene responses. CONCLUSION These preliminary results are consistent with other national estimates and achieve representation of all states and territories. Future work will include longitudinal analysis of NEMSIS datasets and direct survey of transport programs to establish long-term reliability.
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Affiliation(s)
- Andrew P Reimer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States; Critical Care Transport, Cleveland Clinic, 9800 Euclid Ave, Cleveland, OH, 44195, United States.
| | - Joshua Shew
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States.
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Nadkarni VM, Tijssen J, Denny V. Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation for Children-Scoop and Run vs Stay and Play. JAMA Netw Open 2024; 7:e2411616. [PMID: 38767922 DOI: 10.1001/jamanetworkopen.2024.11616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Vinay M Nadkarni
- Anesthesiology, Critical Care and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Janice Tijssen
- Paediatric Critical Care Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Vanessa Denny
- Pediatric Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Okubo M, Komukai S, Izawa J, Chung S, Drennan IR, Grunau BE, Lupton JR, Ramgopal S, Rea TD, Callaway CW. Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children. JAMA Netw Open 2024; 7:e2411641. [PMID: 38767920 PMCID: PMC11107299 DOI: 10.1001/jamanetworkopen.2024.11641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/28/2024] [Indexed: 05/22/2024] Open
Abstract
Importance For pediatric out-of-hospital cardiac arrest (OHCA), emergency medical services (EMS) may elect to transport to the hospital during active cardiopulmonary resuscitation (CPR) (ie, intra-arrest transport) or to continue on-scene CPR for the entirety of the resuscitative effort. The comparative effectiveness of these strategies is unclear. Objective To evaluate the association between intra-arrest transport compared with continued on-scene CPR and survival after pediatric OHCA, and to determine whether this association differs based on the timing of intra-arrest transport. Design, Setting, and Participants This cohort study included pediatric patients aged younger than 18 years with EMS-treated OHCA between December 1, 2005 and June 30, 2015. Data were collected from the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective 10-site OHCA registry in the US and Canada. Data analysis was performed from May 2022 to February 2024. Exposures Intra-arrest transport, defined as an initiation of transport prior to the return of spontaneous circulation, and the interval between EMS arrival and intra-arrest transport. Main Outcomes and Measures The primary outcome was survival to hospital discharge. Patients who underwent intra-arrest transport at any given minute after EMS arrival were compared with patients who were at risk of undergoing intra-arrest transport within the same minute using time-dependent propensity scores calculated from patient demographics, arrest characteristics, and EMS interventions. We examined subgroups based on age (<1 year vs ≥1 year). Results Of 2854 eligible pediatric patients (median [IQR] age, 1 [0-9] years); 1691 males [59.3%]) who experienced OHCA between December 2005 and June 2015, 1892 children (66.3%) were treated with intra-arrest transport and 962 children (33.7%) received continued on-scene CPR. The median (IQR) time between EMS arrival and intra-arrest transport was 15 (9-22) minutes. In the propensity score-matched cohort (3680 matched cases), there was no significant difference in survival to hospital discharge between the intra-arrest transport group and the continued on-scene CPR group (87 of 1840 patients [4.7%] vs 95 of 1840 patients [5.2%]; risk ratio [RR], 0.81 [95% CI, 0.59-1.10]). Survival to hospital discharge was not modified by the timing of intra-arrest transport (P value for the interaction between intra-arrest transport and time to matching = .10). Among patients aged younger than 1 year, intra-arrest transport was associated with lower survival to hospital discharge (RR, 0.52; 95% CI, 0.33-0.83) but there was no association for children aged 1 year or older (RR, 1.22; 95% CI, 0.77-1.93). Conclusions and Relevance In this cohort study of a North American OHCA registry, intra-arrest transport compared with continued on-scene CPR was not associated with survival to hospital discharge among children with OHCA. However, intra-arrest transport was associated with a lower likelihood of survival to hospital discharge among children aged younger than 1 year.
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Affiliation(s)
- Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junichi Izawa
- Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
- Department of Preventive Services, Graduate School of Public Health, Kyoto University, Kyoto, Japan
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - SunHee Chung
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Ian R. Drennan
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian E. Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua R. Lupton
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thomas D. Rea
- Department of Medicine, University of Washington, Seattle
| | - Clifton W. Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Norii T, Nakao S, Miyoshi T, Hatanaka T, Miyake T, Okunaga A, Albright D, Braude D, Sklar DP, Yang M, Crandall C. Ambulance Traffic Crashes in Japan: Characteristics of Casualties and Efforts to Improve Ambulance Safety. PREHOSP EMERG CARE 2024; 28:598-608. [PMID: 38345309 DOI: 10.1080/10903127.2024.2315946] [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: 08/02/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND An ambulance traffic crash not only leads to injuries among emergency medical service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, seatbelt use for casualties (ie, both fatal and nonfatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan. METHODS We conducted a nationwide survey of all fire departments in Japan. The survey queried each fire department about the number of ambulance crashes between January 1, 2017, and December 31, 2019, the number of casualties, their locations, and seatbelt usage. Additionally, the survey collected information on fire department characteristics, including the number of ambulance dispatches, and their safety efforts including emergency vehicle operation training and seatbelt policies. We used regression methods including a zero-inflated negative binomial model to identify factors associated with the number of crashes. RESULTS Among the 726 fire departments in Japan, 553 (76.2%) responded to the survey, reporting a total of 11,901,210 ambulance dispatches with 1,659 ambulance crashes (13.9 for every 100,000 ambulance dispatches) that resulted in a total of 130 casualties during the 3-year study period (1.1 in every 100,000 dispatches). Among the rear cabin occupants, seatbelt use was limited for both EMS professionals (n = 3/29, 10.3%) and patients/companions (n = 3/26, 11.5%). Only 46.7% of the fire departments had an internal policy regarding seatbelt use. About three-fourths of fire departments (76.3%) conducted emergency vehicle operation training internally. The output of the regression model revealed that fire departments that conduct internal emergency vehicle operation training had fewer ambulance crashes compared to those that do not (odds of being an excessive zero -2.20, 95% CI: -3.6 to -0.8). CONCLUSION Two-thirds of fire departments experienced at least one crash during the study period. The majority of rear cabin occupants who were injured in ambulance crashes were not wearing a seatbelt. Although efforts to ascertain seatbelt compliance were limited, Japanese fire departments have attempted a variety of methods to reduce ambulance crashes including internal emergency vehicle operation training, which was associated with fewer ambulance crashes.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoyuki Miyoshi
- Mobility Evaluation and Engineering Division, Advanced R&D and Engineering Company, Toyota Motor Corporation, Toyota, Aichi, Japan
| | - Tetsuo Hatanaka
- Department of Emergency Medicine, Kenwakai Otemachi Hospital, Kitakyushu, Fukuoka, Japan
| | - Tasuku Miyake
- Department of Surgery, Kenwakai Otemachi Hospital, Kitakyushu, Fukuoka, Japan
| | - Aya Okunaga
- Ishii-Care Clinic, Iwakuni, Yamaguchi, Japan
| | - Danielle Albright
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Darren Braude
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - David P Sklar
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - MingAn Yang
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Valentin JB, Hansen NH, Behrndtz AB, Væggemose U, Gude MF. Effect of urgency level on prehospital emergency transport times: a natural experiment. Intern Emerg Med 2024; 19:445-453. [PMID: 38123903 PMCID: PMC10954969 DOI: 10.1007/s11739-023-03501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Accurate estimation of ambulance transport time from the scene of incident to arrival at the emergency department (ED) is important for effective resource management and emergency care system planning. Further, differences in transport times between different urgency levels highlight the benefits of ambulance transports with highest urgency level in a setting where ambulances are allowed to not follow standard traffic rules. The objective of the study is to compare ambulance urgency level on the differences in estimates of ambulance transport times generated by Google Maps and the observed transport times in a prehospital setting where emergency vehicles have their own traffic laws. The study was designed as a natural experiment and register study. Ambulance transports dispatched with different levels of urgency (Level A and B) were included in the Central Denmark Region (a mixed urban and rural area) from March 10 to June 11, 2021. Ambulance transports for highest urgency level were compared to lowest urgency level with Google Maps estimated transport times as reference. We analyzed 1981 highest urgency level and 8.958 lowest urgency level ambulance transports. Google Maps significantly overestimated the duration of transports operating at highest level of urgency (Level A) by 1.9 min/10 km (95% CI 1.8; 2.0) in average and 4.8 min/10 km (95% CI 3.9; 5.6) for the first driven 10 km. Contrary, Google Maps significantly underestimated the duration of transports operating at lowest level of urgency (Level B) by -1.8 min/10 km (95% CI -2.1; -1.5) in average and -4.4 min/10 km (95% CI -5.4; -3.5) for the first driven 10 km. Google Maps systematically overestimates transport times of ambulance transports driven with Level A, the highest level of urgency in a setting where ambulances are allowed to not follow standard traffic rules. The results highlight the benefit of using urgency Level A and provide valuable information for emergency care management.
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Affiliation(s)
- Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Nanna Høgh Hansen
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| | | | - Ulla Væggemose
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin Faurholdt Gude
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
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Hansen PM, Nielsen MS, Rehn M, Lassen AT, Mikkelsen S, Perner A, Brøchner AC. Ambulance and helicopter response time. Association with patient outcome and illness severity: Protocol of a systematic literature review and meta-analysis. Acta Anaesthesiol Scand 2024; 68:287-296. [PMID: 37870745 DOI: 10.1111/aas.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Response time for emergency medical service units is a key performance indicator. Studies have shown reduced response time association with improved outcome for specific critical conditions. To achieve short response time, emergency vehicles utilize lights and sirens, and crews are allowed to be non-compliant with traffic rules, posing a risk for accident. The purpose of the systematic review and meta-analysis is to provide an overview of the current body of evidence regarding the association, if any, between ambulance and helicopter response time and major complications and mortality in patients conveyed by ambulance and/or helicopter. Our secondary aim will be to enhance knowledge in the field of criteria-based dispatch to provide decision makers with evidence to optimize dispatch of limited resources. RESEARCH QUESTIONS What is the association between overall emergency medical services unit response time and patient outcomes, major complications, and time-critical conditions? What is the internal and external validity of the included literature? METHODS We plan the systematic review and meta-analysis to be in accordance with the Cochrane Handbook and Joanna Briggs Institute Manual for Systematic Reviews. The methodology will include formulating the review questions using a Population, Exposure, and Outcome framework. Every study design is eligible, including qualitative, quantitative, and mixed-methods designs. We will include all articles in English, Scandinavian, German, French and Portuguese in this systematic review. RESULTS We will publish results from the systematic review and meta-analysis in a peer-reviewed journal and we will present the results at scientific conferences and meetings. Results will also be available at www.ahrtemis.dk. CONCLUSION We will base our conclusions on the findings of the review and meta-analysis.
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Affiliation(s)
- Peter Martin Hansen
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital Svendborg, Odense C, Denmark
- Prehospital Research Unit, Region of South Denmark, Odense C, Denmark
| | - Martine Siw Nielsen
- Department of Anesthesiology and Intensive Care Medicine, Sygehus Lillebaelt, Kolding, Denmark
| | - Marius Rehn
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | | | - Søren Mikkelsen
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense C, Denmark
| | - Anders Perner
- Department of Anesthesiology and Intensive Care Medicine, Rigshospitalet, København Ø, Denmark
| | - Anne Craveiro Brøchner
- Prehospital Research Unit, Region of South Denmark, Odense C, Denmark
- Department of Anesthesiology and Intensive Care Medicine, Sygehus Lillebaelt, Kolding, Denmark
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Mills AAM, Mills EHA, Blomberg SNF, Christensen HC, Møller AL, Gislason G, Køber L, Kragholm KH, Lippert F, Folke F, Andersen MP, Torp-Pedersen C. Ambulance response times and 30-day mortality: a Copenhagen (Denmark) registry study. Eur J Emerg Med 2024; 31:59-67. [PMID: 37788140 DOI: 10.1097/mej.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND IMPORTANCE Ensuring prompt ambulance responses is complicated and costly. It is a general conception that short response times save lives, but the actual knowledge is limited. OBJECTIVE To examine the association between the response times of ambulances with lights and sirens and 30-day mortality. DESIGN A registry-based cohort study using data collected from 2014-2018. SETTINGS AND PARTICIPANTS This study included 182 895 individuals who, during 2014-2018, were dispatched 266 265 ambulances in the Capital Region of Denmark. OUTCOME MEASURES AND ANALYSIS The primary outcome was 30-day mortality. Subgroup analyses were performed on out-of-hospital cardiac arrests, ambulance response priority subtypes, and caller-reported symptoms of chest pain, dyspnoea, unconsciousness, and traffic accidents. The relation between variables and 30-day mortality was examined with logistic regression. RESULTS Unadjusted, short response times were associated with higher 30-day mortality rates across unadjusted response time quartiles (0-6.39 min: 9%; 6.40-8.60 min: 7.5%, 8.61-11.80 min: 6.6%, >11.80 min: 5.5%). This inverse relationship was consistent across subgroups, including chest pain, dyspnoea, unconsciousness, and response priority subtypes. For traffic accidents, no significant results were found. In the case of out-of-hospital cardiac arrests, longer response times of up to 10 min correlated with increased 30-day mortality rates (0-6.39 min: 84.1%; 6.40-8.60 min: 86.7%, 8.61-11.8 min: 87.7%, >11.80 min: 85.5%). Multivariable-adjusted logistic regression analysis showed that age, sex, Charlson comorbidity score, and call-related symptoms were associated with 30-day mortality, but response time was not (OR: 1.00 (95% CI [0.99-1.00])). CONCLUSION Longer ambulance response times were not associated with increased mortality, except for out-of-hospital cardiac arrests.
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Affiliation(s)
| | | | | | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
- Danish Clinical Quality Program (RKKP), Rigshospitalet
| | - Amalie Lykkemark Møller
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen
- Department of Cardiology, Nordsjællands Hospital, Hillerød
- Department of Public Health, University of Copenhagen
| | - Gunnar Gislason
- The Danish Heart Foundation, Copenhagen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- Department of Clinical Medicine, University of Copenhagen
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
| | - Frederik Folke
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød
- Department of Public Health, University of Copenhagen
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Afshari A, Torabi M, Navkhasi S, Aslani M, Khazaei A. Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods. BMC Emerg Med 2023; 23:136. [PMID: 37968617 PMCID: PMC10648310 DOI: 10.1186/s12873-023-00906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment. METHODS Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively. RESULTS The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: "the overall impact of the stress crisis on technicians," "missing links in the communication network in incident management," "professional shortcomings in pre-hospital care," and "the complex and multifaceted context of stressful pre-hospital emergencies." Additionally, the study's theme was centered around "surveying the experiences of EMTs in stressful environments." CONCLUSION As the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.
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Affiliation(s)
- Ali Afshari
- Department of Medical Surgical Nursing, Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Torabi
- Department of Nursing, Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sasan Navkhasi
- Department of Prehospital Emergency Medicine, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Marzieh Aslani
- Instructor of Critical Care Nursing, Department of Nursing, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Afshin Khazaei
- Department of Prehospital Emergency Medicine, Asadabad School of Medical Sciences, Asadabad, Iran.
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10
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Carr CT, Becker TK. Out of hospital extracorporeal cardiopulmonary resuscitation: Maybe. Eur J Emerg Med 2023; 30:311-312. [PMID: 37598349 DOI: 10.1097/mej.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
- Casey T Carr
- Division of Critical Care Medicine, Department of Emergency Medicine, College of Medicine, University of Florida, Florida, USA
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11
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Jakonen A, Mänty M, Nordquist H. Applying Crew Resource Management tools in Emergency Response Driving and patient transport-Finding consensus through a modified Delphi study. Int Emerg Nurs 2023; 70:101318. [PMID: 37517359 DOI: 10.1016/j.ienj.2023.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Emergency Response Driving (ERD) comprises a significant risk to safety in Emergency Medical Services (EMS). Crew Resource Management (CRM) tools play a major role in securing actions in high-risk procedures. The aim of this study was to find consensus on the important factors to consider when applying CRM tools in ERD and patient transport. METHODS ERD experts (n = 50) were recruited for a modified three-round Delphi study. Round 1 was based on previous research. The experts evaluated the items as important, neutral, or not important. The predetermined level of consensus was set at ≥ 80%. Answers given to the open-ended questions were analyzed using inductive content analysis. RESULTS Predetermined consensus was reached on 64 of 86 presented items (74.4 %). The mean values of items reaching consensus varied between 3.81 and 4.86 on a five-point Likert scale. The items where consensus was reached were rated as "important" on a trichotomized scale. CONCLUSION Multiple important factors to consider when applying CRM tools to ERD and patient transport were highlighted. This study provides valuable information to consider regarding EMS safety improvements. Further scientific research is needed to develop comprehensive recommendations.
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Affiliation(s)
- Antti Jakonen
- RDI Sustainable Wellbeing, South-Eastern Finland University of Applied Sciences, 48220 Kotka, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, 00140 Helsinki, Finland.
| | - Minna Mänty
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00140 Helsinki, Finland; Unit of Strategy and Research, City of Vantaa, 01300 Vantaa, Finland
| | - Hilla Nordquist
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00140 Helsinki, Finland; Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, 48220 Kotka, Finland; Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland
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12
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Differences between the dispatch priority assessments of emergency medical dispatchers and emergency medical services: a prospective register-based study in Finland. Scand J Trauma Resusc Emerg Med 2023; 31:8. [PMID: 36797760 PMCID: PMC9936687 DOI: 10.1186/s13049-023-01072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Responsive and efficient emergency medical services (EMS) require accurate telephone triage. In Finland, such services are provided by Emergency Response Centre Agency (ERC Agency). In 2018, a new Finnish computer-assisted emergency dispatch system was introduced: the Emergency Response Integrated Common Authorities (ERICA). After the introduction of ERICA, the appropriateness of EMS dispatch has not been investigated yet. The study´s objective is to determine the consistency between the priority triage of the emergency medical dispatcher (EMD) and the on-scene priority assessment of the EMS, and whether the priority assessment consistency varied among the dispatch categories. METHODS This was a prospective register-based study. All EMS dispatches registered in the Tampere University Hospital area from 1 August 2021 to 31 August 2021 were analysed. The EMD's mission priority triaged during the emergency call was compared with the on-scene EMS's assessment of the priority, derived from the pre-set criteria. The test performance levels were measured from the crosstabulation of true or false positive and negative values of the priority assessment. Statistical significance was analysed using the chi-square test and the Kruskal-Wallis H test, and p-values < 0.05 were considered significant. RESULTS Of the 6416 EMS dispatches analysed in this study, 36% (2341) were urgent according to the EMD's dispatch priority, and of these, only 29% (688) were urgent according to the EMS criteria. On the other hand, 64% (4075) of the dispatches were non-urgent according to the EMD's dispatch priority, of which 97% (3949) were non-urgent according to the EMS criteria. Moreover, there were differences between the EMD and EMS priority assessments among the dispatch categories (p < 0.001). The overall efficiency was 72%, sensitivity 85%, specificity 71%, positive predictive value 29%, and negative predictive value 97%. CONCLUSION While the EMD recognised the non-urgent dispatches with high consistency with the EMS criteria, most of the EMD's urgent dispatches were not urgent according to the same criteria. This may diminish the availability of the EMS for more urgent missions. Thus, measures are needed to ensure more accurate and therefore, more efficient use of EMS resources in the future.
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13
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Spigner M, Braude D, Pruett K, Ortiz C, Glazer J, Marinaro J. The Use of Predictive Modeling to Compare Prehospital eCPR Strategies. PREHOSP EMERG CARE 2023; 27:184-191. [PMID: 35639014 DOI: 10.1080/10903127.2022.2079782] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The duration of low flow prior to initiation of extracorporeal cardiopulmonary resuscitation (eCPR) appears to influence survival. Strategies to reduce the low-flow interval for out-of-hospital cardiac arrest have been focused on expediting patient transport to the hospital or initiating extracorporeal support in the prehospital setting. To date, a direct comparison of low-flow interval between these strategies has not been made. To attempt this comparison, a model was created to predict low-flow intervals for each strategy at different locations across the city of Albuquerque, New Mexico. The data, specific to Albuquerque, suggest that a prehospital cannulation strategy consistently outperforms an expedited transport strategy, with an estimated difference in low-flow interval of 34.3 to 37.2 minutes, depending on location. There is no location within the city in which an expedited transport strategy results in a shorter low-flow interval than prehospital cannulation. It would be rare to successfully initiate eCPR by either strategy in fewer than 30 minutes from the time of patient collapse. Using a prehospital cannulation strategy, the entire coverage area could be eligible for eCPR within 60 minutes of patient collapse. The use of predictive modeling can be a low-cost solution to assist with strategic deployment of prehospital resources and may have potential for real-time decision support for prehospital clinicians.
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Affiliation(s)
- Michael Spigner
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA.,BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Darren Braude
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kimberly Pruett
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Chris Ortiz
- Albuquerque Fire-Rescue, Albuquerque, New Mexico, USA
| | - Joshua Glazer
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Jonathan Marinaro
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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14
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Norii T, Nakao S, Miyoshi T, Braude D, Sklar DP, Crandall C. Driving Ambulances Safely: Findings of Ten Years of Japanese Ambulance Crash Data. PREHOSP EMERG CARE 2023; 27:94-100. [PMID: 34874807 DOI: 10.1080/10903127.2021.2015026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Rules and regulations for ambulance operations differ across countries and regions, however, little is known about ambulance crashes outside of the United States. Japan is unique in several aspects, for example, routine use of lights and sirens during response and transport regardless of the urgency of the case and low speed limits for ambulances. The aim of this study was to describe the incidence and characteristics of ambulance crashes in Japan. METHODS We retrospectively analyzed data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) that include all traffic crashes resulting in injury or death in Japan. The study included all ambulance crashes from 2009 to 2018. We compared crashes that occurred during emergency operations with lights and sirens (i.e., when responding to a call or transporting a patient) to those that occurred during non-emergency operations without lights or sirens. We also used data on total number of ambulance dispatches from the Japanese Fire and Disaster Management Agency to calculate ambulance crash risk. RESULTS During the 10-year period, we identified a total of 486 ambulance crashes out of 59,208,761 ambulance dispatches (0.82 in every 100,000 dispatches or one crash for every 121,829 dispatches) that included two fatal crashes. Among all ambulance crashes, 142 (29.2%) occurred during emergency operations. The incidence of ambulance crashes decreased significantly over the 10-year period. Ambulance crashes at an intersection occurred more frequently during emergency operations than during non-emergency operations (72.5% vs. 58.1%; 14.4% difference, 95% CI 5.0-22.9). CONCLUSIONS Ambulance crashes occurred infrequently in Japan with crash rates much lower than previously reported crash rates in the United States. Ambulance crashes during emergency operations occurred more frequently at intersections compared to non-emergency operations. Further investigation of the low Japanese ambulance crash rates could provide opportunities to improve ambulance safety in other countries.
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Affiliation(s)
- Tatsuya Norii
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoyuki Miyoshi
- Mobility Evaluation and Engineering Division, Advanced R&D and Engineering Company, Toyota Motor Corporation, Toyota, Aichi, Japan
| | - Darren Braude
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Anesthesiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - David P Sklar
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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15
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Hartmann K, Lubin J, Boehmer S, Amin S, Flamm A. Ground Versus Air: Which Mode of Emergency Medical Service Transportation Is More Likely to Crash? Air Med J 2023; 42:28-35. [PMID: 36710032 DOI: 10.1016/j.amj.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We analyzed helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) crash data in the United States during 1983 to 2020 to compare incidences of total, fatal, and injury crashes. METHODS HEMS and GEMS total, fatal, and injury crashes during 1983 to 2020 and 1988 to 2020, respectively, were analyzed in this retrospective study. Data were obtained from the National Transportation Safety Board and the National Highway Traffic Safety Administration. Additional data from the Federal Aviation Administration, the National Emergency Medical Services Information System, and prior literature were used for rate calculations. A Poisson regression model was used to determine rate ratios with 95% confidence intervals comparing total, fatal, and injury crash rates from 2016 to 2020. RESULTS HEMS crash rates decreased since 1983. Total GEMS crashes have increased since 1988. Of the total crashes, 33% (HEMS) and 1% (GEMS) were fatal, and 20% (HEMS) and 31% (GEMS) resulted in injury. During 2016 to 2020, GEMS crash rates were 11.0 times higher than HEMS crash rates (95% confidence interval, 5.2-23.3; P < .0001). CONCLUSION HEMS has a lower crash probability than GEMS. The availability of data is a limitation of this study. National GEMS transportation data could be useful in studying this topic further.
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Affiliation(s)
- Krista Hartmann
- Pennsylvania State University College of Medicine, Hershey, PA
| | - Jeffrey Lubin
- Pennsylvania State University College of Medicine, Hershey, PA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Sue Boehmer
- Pennsylvania State University College of Medicine, Hershey, PA
| | - Sibgha Amin
- Pennsylvania State University, State College, PA
| | - Avram Flamm
- Pennsylvania State University College of Medicine, Hershey, PA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
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16
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Kurosaki H, Takada K, Okajima M. Time point for transport initiation in out-of-hospital cardiac arrest cases with ongoing cardiopulmonary resuscitation: a nationwide cohort study in Japan. Acute Med Surg 2022; 9:e802. [PMID: 36285104 PMCID: PMC9585045 DOI: 10.1002/ams2.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/02/2022] [Indexed: 11/10/2022] Open
Abstract
Aim This study aimed to investigate the time point of the decision to initiate transport with ongoing cardiopulmonary resuscitation (CPR) in Japan. Methods We analyzed adult out-of-hospital cardiac arrest (OHCA) cases that achieved return of spontaneous circulation (ROSC) before hospital arrival from the All-Japan Utstein Registry during 2015-2017. We constructed receiver operating characteristics (ROC) curves to illustrate the ability of achieving ROSC as a predictor of neurologically favorable outcomes as a function of increasing time points of resuscitation before ROSC. Furthermore, a multivariable logistic regression analysis was carried out to identify factors associated with outcomes. Results Of 373,993 OHCA patients with attempted resuscitation during 2015-2017, 22,067 patients with prehospital ROSC were included in our study. Patients were divided into the shockable initial rhythm (n = 5,580) and nonshockable initial rhythm (n = 16,487) cohorts. The ROC curves showed 10 min was the best test performance time point for a neurologically favorable outcome for shockable initial rhythm patients (sensitivity, 0.78; specificity, 0.53; area under the ROC curve [AUC], 0.70) and 8 min for nonshockable initial rhythm patients (sensitivity, 0.74; specificity, 0.77; AUC, 0.83). Multivariable logistic regression analyses revealed that CPR durations using the cut-off value were independently associated with better outcomes for both shockable initial rhythm patients (odds ratio, 2.09; 95% confidence interval, 1.81-2.42) and nonshockable initial rhythm patients (odds ratio, 3.34; 95% confidence interval, 2.92-3.82). Conclusion When Japanese emergency medical service (EMS) providers attend OHCA cases, the decision to initiate transport with ongoing CPR should be made at approximately 10 min after EMS providers initiate CPR for shockable initial rhythm patients and at approximately 8 min for nonshockable initial rhythm patients.
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Affiliation(s)
- Hisanori Kurosaki
- Department of Circulatory Emergency and Resuscitation ScienceKanazawa University Graduate School of MedicineKanazawaJapan,Department of Prehospital Emergency Medical Sciences, Faculty of Health SciencesHiroshima International UniversityHigashihiroshimaJapan
| | - Kohei Takada
- Department of Circulatory Emergency and Resuscitation ScienceKanazawa University Graduate School of MedicineKanazawaJapan
| | - Masaki Okajima
- Department of Circulatory Emergency and Resuscitation ScienceKanazawa University Graduate School of MedicineKanazawaJapan
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17
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Ceklic E, Tohira H, Ball S, Brown E, Brink D, Bailey P, Brits R, Finn J. A predictive ambulance dispatch algorithm to the scene of a motor vehicle crash: the search for optimal over and under triage rates. BMC Emerg Med 2022; 22:74. [PMID: 35524169 PMCID: PMC9074212 DOI: 10.1186/s12873-022-00609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Calls for emergency medical assistance at the scene of a motor vehicle crash (MVC) substantially contribute to the demand on ambulance services. Triage by emergency medical dispatch systems is therefore important, to ensure the right care is provided to the right patient, in the right amount of time. A lights and sirens (L&S) response is the highest priority ambulance response, also known as a priority one or hot response. In this context, over triage is defined as dispatching an ambulance with lights and sirens (L&S) to a low acuity MVC and under triage is not dispatching an ambulance with L&S to those who require urgent medical care. We explored the potential for crash characteristics to be used during emergency ambulance calls to identify those MVCs that required a L&S response. Methods We conducted a retrospective cohort study using ambulance and police data from 2014 to 2016. The predictor variables were crash characteristics (e.g. road surface), and Medical Priority Dispatch System (MPDS) dispatch codes. The outcome variable was the need for a L&S ambulance response. A Chi-square Automatic Interaction Detector technique was used to develop decision trees, with over/under triage rates determined for each tree. The model with an under/over triage rate closest to that prescribed by the American College of Surgeons Committee on Trauma (ACS COT) will be deemed to be the best model (under triage rate of ≤ 5% and over triage rate of between 25–35%. Results The decision tree with a 2.7% under triage rate was closest to that specified by the ACS COT, had as predictors—MPDS codes, trapped, vulnerable road user, anyone aged 75 + , day of the week, single versus multiple vehicles, airbag deployment, atmosphere, surface, lighting and accident type. This model had an over triage rate of 84.8%. Conclusions We were able to derive a model with a reasonable under triage rate, however this model also had a high over triage rate. Individual EMS may apply the findings here to their own jurisdictions when dispatching to the scene of a MVC. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00609-5.
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Affiliation(s)
- Ellen Ceklic
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Emergency Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,St John Western Australia, Belmont, WA, Australia
| | | | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,St John Western Australia, Belmont, WA, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,St John Western Australia, Belmont, WA, Australia
| | | | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Emergency Medicine, Medical School, The University of Western Australia, Perth, Australia.,St John Western Australia, Belmont, WA, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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18
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Reid BO, Næss-Pleym LE, Haugland H, Dale J, Uleberg O, Nordstrand AE. Posttraumatic Stress Responses and Psychological Well-being in Norwegian Medical Helicopter Personnel. Air Med J 2022; 41:292-297. [PMID: 35595337 DOI: 10.1016/j.amj.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Emergency medical personnel are exposed to multiple stressors, including those of psychological etiologies. The aim of this study was to report the prevalence of anxiety, depression, and posttraumatic stress symptoms in Norwegian medical helicopter personnel and to determine to what degree they report personal growth or deprecation due to exposure to work-related events. METHODS This was a web-based, cross-sectional survey performed among rescue paramedics and physicians staffing helicopter emergency medical services and search and rescue helicopters between May 5, 2021, and July 5, 2021. Questions included demographic data, the traumatic events exposure index, the Generalized Anxiety Disorder 7 scale, the Patient Health Questionnaire 9 (Depression), the posttraumatic change scale, and the posttraumatic symptom scale. RESULTS Of the 245 eligible participants, 10 declined to take part and 74 failed to answer, producing a response rate of 66% (72 rescue paramedics and 89 physicians). Of the study population, 3.9 % reported manifest posttraumatic stress disorder symptoms, and 1.9% described moderate to severe depression and anxiety. The majority (76%) described posttraumatic emotional growth because of their work experience. CONCLUSION Despite exposure to several traumatic stressors, participants reported a lower prevalence of posttraumatic stress symptoms, depression, and anxiety compared with a Norwegian adult population.
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Affiliation(s)
- Bjørn Ole Reid
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway; Joint Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway.
| | - Lars Eide Næss-Pleym
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway; Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway
| | - Jostein Dale
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Trondheim, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Andreas Espetvedt Nordstrand
- Joint Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway; Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Kupas DF, Zavadsky M, Burton B, Baird S, Clawson JJ, Decker C, Dworsky PI, Evans B, Finger D, Goodloe JM, LaCroix B, Ludwig GG, McEvoy M, Tan DK, Thornton KL, Smith K, Wilson BR. Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services Responses. PREHOSP EMERG CARE 2022; 26:459-461. [PMID: 35475941 DOI: 10.1080/10903127.2022.2044417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Douglas F Kupas
- Division of Emergency Medical Services, Geisinger Health System
| | | | | | | | - Jeff J Clawson
- Division of Research, Academics, and Standards, International Academies of Emergency Dispatch
| | | | | | - Bruce Evans
- National Association of Emergency Medical Technicians
| | | | - Jeffrey M Goodloe
- Department of Emergency Medicine, University of Oklahoma School of Community Medicine
| | | | | | | | - David K Tan
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Kevin Smith
- Niagara Emergency Medical Services, Niagara on the Lake, ON
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20
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Alwidyan MT, Oteir AO, Alrawashdeh A, Maabreh GM, Williams B. Road user perceptions of appropriateness of ambulance lights and sirens use in developing countries. Int Emerg Nurs 2022; 62:101157. [PMID: 35339105 DOI: 10.1016/j.ienj.2022.101157] [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: 05/06/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Ambulance lights and sirens use has traditionally been an important strategy to shorten ambulance travel times. This study explored road users' perceptions toward the importance and risks of lights and sirens use by ambulances in Jordan. METHODS A cross-sectional survey was used on a sample of 1700 adult road users in Northern Jordan. The questionnaire included 19 items addressing demographics, driving-related characteristics, and perception statements toward lights and sirens use. Continuous variables were summarized as means and standard deviation and categorical variables were reported as frequencies and percentages. Chi-square test was used to assess differences between categorical variable. RESULTS A total of 1634 participants completed the questionnaire. The mean age was 32.4 (SD ± 11.4) years, and 65.4% were males. Most participants agreed on the importance of using lights and sirens for emergency medical services to function effectively (96.5%), and penalizing those who do not yield to emergency ambulances (90.2%). However, around half of the participants perceive that lights and sirens could be over-used by ambulance personnel (48.1%), provoke distraction (48.7%) and create stress (50.3%) for road users. These negative perceptions were reported more often among males, taxi/bus drivers, and novice drivers. CONCLUSIONS Although the majority of road users, in our region, acknowledge the importance of ambulance lights and sirens use, about half of them perceive that ambulance lights and sirens put them under stress, distraction, and unacceptable risk. Policy-related and educational interventions might be necessary to monitor the use of ambulance lights and sirens and reduce negative road users' perceptions.
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Affiliation(s)
- Mahmoud T Alwidyan
- Paramedics Program, Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Alaa O Oteir
- Paramedics Program, Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
| | - Ahmad Alrawashdeh
- Paramedics Program, Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Ghaidaa M Maabreh
- Paramedics Program, Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Brett Williams
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
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Structured communication during emergency response driving: Safety-critical points identified by Finnish emergency response driving experts. Australas Emerg Care 2022; 25:308-315. [DOI: 10.1016/j.auec.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
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Abstract
An emergency can occur at any time. To overcome that emergency efficiently, we require seamless movement on the road to approach the destination within a limited time by using an Emergency Vehicle (EV). This paper proposes an emergency vehicle management solution (EVMS) to determine an efficient vehicle-passing sequence that allows the EV to cross a junction without any delay. The proposed system passes the EV and minimally affects the travel times of other vehicles on the junction. In the presence of an EV in the communication range, the proposed system prioritizes the EV by creating space for it in the lane adjacent to the shoulder lane. The shoulder lane is a lane that cyclists and motorcyclists will use in normal situations. However, when an EV enters the communication range, traffic from the adjacent lane will move to the shoulder lane. As the number of vehicles on the road increases rapidly, crossing the EV in the shortest possible time is crucial. The EVMS and algorithms are presented in this study to find the optimal vehicle sequence that gives EVs the highest priority. The proposed solution uses cutting-edge technologies (IoT Sensors, GPS, 5G, and Cloud computing) to collect and pass EVs’ information to the Roadside Units (RSU). The proposed solution was evaluated through mathematical modeling. The results show that the EVMS can reduce the travel times of EVs significantly without causing any performance degradation of normal vehicles.
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Reid BO, Næss-Pleym LE, Bakkelund KE, Dale J, Uleberg O, Nordstrand AE. A cross-sectional study of mental health-, posttraumatic stress symptoms and post exposure changes in Norwegian ambulance personnel. Scand J Trauma Resusc Emerg Med 2022; 30:3. [PMID: 35016708 PMCID: PMC8749923 DOI: 10.1186/s13049-021-00991-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background Posttraumatic stress disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services, fire service, police force) compared to the general population. Examining the prevalence of mental health issues in a work force with an elevated occupational risk is fundamental towards ensuring their wellbeing and implementing safeguard measures. The goal of this study is therefore to report the prevalence of depression, anxiety, posttraumatic development, and PTSD in Norwegian ambulance personnel. Methods This study is a cross-sectional, anonymous, web-based survey (Questback®), performed among operative personnel employed in the Emergency Medical Services in the Regional Health Trust of Central Norway between 18. February and 9. April 2021. The study was sent to 1052 eligible participants. Questions reported demographic data, a traumatic events exposure index, Patient Health Questionnaire-9 (Depression), Generalized Anxiety Disorder-7 scale, Posttraumatic symptom scale (PTSD) and Posttraumatic change scale. Results The response rate in this study was 45.5% (n = 479/1052). The mean age of respondents was 37.1 years (std. 11.1) and 52.8% (n = 253) were male. Of the respondents, 80.6% (n = 386) were married or had a partner, and 91.6% (n = 439) reported having access to a peer support programme, with 34.9% (n = 167) reporting that they had utilized peer support. In this study, 5% (n = 24) showed a prevalence of manifest posttraumatic stress disorder symptoms, while 8.6% (n = 41) reported moderate to severe depression and 2.9% (n = 14) presented moderate to severe symptoms of general anxiety. Of the respondents, 77.2% (n = 370) reported personal growth because of their work experiences. Conclusions This study indicates that Norwegian ambulance personnel report a prevalence of posttraumatic stress symptoms and depression, which is slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seem to influence levels of posttraumatic stress and -development. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00991-2.
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Affiliation(s)
- Bjørn Ole Reid
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Prinsesse Kristinas gate 3, AHL, 7030, Trondheim, Norway. .,Joint Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway.
| | - Lars Eide Næss-Pleym
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Prinsesse Kristinas gate 3, AHL, 7030, Trondheim, Norway.,Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Karin Elvenes Bakkelund
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Prinsesse Kristinas gate 3, AHL, 7030, Trondheim, Norway
| | - Jostein Dale
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Prinsesse Kristinas gate 3, AHL, 7030, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Prehospital Services, St. Olav's Hospital, Prinsesse Kristinas gate 3, AHL, 7030, Trondheim, Norway.,Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Espetvedt Nordstrand
- Joint Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway.,Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Abe T, Kanemaru K, Saito K, Ueda T, Ochiai H. Physician-Staffed Emergency Vehicle Crash: A Case Report. Cureus 2022; 14:e21027. [PMID: 35154997 PMCID: PMC8819582 DOI: 10.7759/cureus.21027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/05/2022] Open
Abstract
Physician-staffed vehicles are widely operated in many countries. There is a paucity of literature regarding physician-staffed emergency vehicle accidents. On an evening in January 2016, at the request of the fire department, a physician-staffed vehicle was dispatched with two physicians, a nurse, and a driver from the base hospital to the scene of a patient with cardiopulmonary arrest. The vehicle ran with the alerting siren and warning lights. On its way, the vehicle struck a car and the mission was canceled. The patient was transported to another hospital by the ambulance staff only. No passengers were injured. One physician and a nurse examined the driver of the struck car and transported the driver to the base hospital by additional ambulance units. Because there were no manuals or guidelines, the staff responses were not systematic. After the repair of the crashed vehicle and preparation of operation manuals for two months, the physician-staffed vehicle returned to service, and it has worked without any accident since then. The physician-staffed vehicle is of benefit to critical victims and it rarely crashes. When the vehicle is involved in an accident, it results in multiple victims as well as additional emergency demands. Warning lights and sirens in the dark at a four-point crossroads might increase the risk of crashing. Information influx from the emergency scenes might distract the physicians’ attention and put stress on the driver, leading to dangerous high-speed emergency driving. Educational training and manuals in each hospital and a nationwide framework regarding safety operations and accidents are needed.
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Becker J, Hugelius K. Driving the ambulance: an essential component of emergency medical services: an integrative review. BMC Emerg Med 2021; 21:160. [PMID: 34922453 PMCID: PMC8684175 DOI: 10.1186/s12873-021-00554-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/06/2021] [Indexed: 04/28/2023] Open
Abstract
Background The transport of patients from one location to another is a fundamental part of emergency medical services. However, little interest has been shown in the actual driving of the ambulance. Therefore, this review aimed to investigate how the driving of the ambulance affects the patient and the medical care provided in an emergency medical situation. Methods A systematic integrative review using both quantitative and qualitative designs based on 17 scientific papers published between 2011 and 2020 was conducted. Results Ambulance driving, both the actual speed, driving pattern, navigation, and communication between the driver and the patient, influenced both the patient’s medical condition and the possibility of providing adequate care during the transport. The driving itself had an impact on prehospital time spent on the road, safety, comfort, and medical issues. The driver’s health and ability to manage stress caused by traffic, time pressure, sirens, and disturbing moments also significantly influenced ambulance transport safety. Conclusions The driving of the ambulance had a potential effect on patient health, wellbeing, and safety. Therefore, driving should be considered an essential part of the medical care offered within emergency medical services, requiring specific skills and competence in both medicine, stress management, and risk approaches in addition to the technical skills of driving a vehicle. Further studies on the driving, environmental, and safety aspects of being transported in an ambulance are needed from a patient’s perspective.
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Affiliation(s)
- Julia Becker
- Institute for Disaster and Emergency Management, 141 69, Berlin, Germany
| | - Karin Hugelius
- Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden.
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Jung E, Ro YS, Ryu HH, Kong SY, Lee SY. Effect of implementation of multi-tier response system and prolonged on-scene resuscitation for out-of-hospital cardiac arrest. Am J Emerg Med 2021; 51:79-84. [PMID: 34688965 DOI: 10.1016/j.ajem.2021.09.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The purpose of this study was to explain the process and results of implementing a bundle of two cardiopulmonary resuscitation (CPR) programs in Gwang-ju metropolitan city and to determine whether the use of these programs improved the clinical outcomes for out-of-hospital cardiac arrest (OHCA) patients. METHODS This was a before- and after-intervention study of the implementation of a bundle of two CPR programs in Gwang-ju. The main intervention was a multi-tier response (MTR) system, with an emphasis on prolonged on-scene resuscitation. The primary outcome was good neurological recovery, and secondary outcomes were survival to discharge and prehospital return of spontaneous circulation (ROSC). A multivariable logistic regression model was used to estimate the association between the study period and outcomes, after adjusting for potential confounders. Interaction analysis was conducted to determine whether the location of arrest and witness status modified the effect of the study period on the study outcomes. RESULTS The adjusted odds ratios (AORs) for the intervention were 1.35 (0.96-1.90) for pre-hospital ROSC, 1.19 (0.49-2.86) for survival to discharge, and 3.45 (1.01-11.80) for good CPC. The AORs for good neurological recovery of the after-intervention period were 2.93 (0.73-11.77) for a private place, 4.82 (1.04-22.39) for a public place, 5.88 (1.47-23.57) for a witnessed arrest, and 1.49 (0.28-7.86) for a non-witnessed arrest. CONCLUSIONS OHCA patients treated in the after-intervention period with the bundle of CPR programs including MTR and prolonged on-scene resuscitation showed better clinical outcomes, especially pre-hospital ROSC, and neurological recovery at hospital discharge than those treated in the before-intervention period.
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Affiliation(s)
- Eujene Jung
- Department of Emergency medicine, Chonnam National University Hospital, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency medicine, Chonnam National University Hospital, Republic of Korea; Chonnam National University College of Medicine, Republic of Korea.
| | | | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Republic of Korea
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Carlisle EM, Bagwell CE. Ethical challenges with decisions to withhold or withdraw resuscitation in pediatric surgery. Semin Pediatr Surg 2021; 30:151096. [PMID: 34635284 DOI: 10.1016/j.sempedsurg.2021.151096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Providers often dispute the ethical equivalence of withholding and withdrawing care, despite theoretical frameworks that support equivalency. We highlight two cases, one where providers express concern with initiation of aggressive resuscitation and another where providers experience emotional distress from the decision to cease resuscitation. Both cases illustrate how the ethical challenges encountered can result in high levels of provider distress. Mitigation of this moral distress by team members will require an improved understanding of available evidence in the literature and active discussion by debriefing after a child dies. Medical staff and national organizations can help recognize that these patient events contribute to provider burnout and facilitate the design and support of programs to increase provider resiliency.
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Affiliation(s)
- Erica M Carlisle
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, USA; Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, USA.
| | - Charles E Bagwell
- Department of Surgery, Division of Pediatric Surgery, Virginia Commonwealth University/Medical College of Virginia, USA
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Grunau B, Kawano T, Rea TD, Okubo M, Scheuermeyer FX, Reynolds JC, Heidet M, Drennan IR, Cheskes S, Fordyce CB, Twaites B, Christenson J. Emergency medical services employing intra-arrest transport less frequently for out-of-hospital cardiac arrest have higher survival and favorable neurological outcomes. Resuscitation 2021; 168:27-34. [PMID: 34509554 DOI: 10.1016/j.resuscitation.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is substantial regional variation in out-of-hospital cardiac arrest (OHCA) survival. We investigated whether regional emergency medical services (EMS) intra-arrest transport (IAT) practices are associated with patient outcomes. METHODS We performed a secondary analysis of a multi-center North American clinical trial dataset, which enrolled EMS-treated adult OHCA cases from 49 regional population-based clusters. The exposure of interest was regional-level intra-arrest transport (IAT), calculated as the proportion of cases in each cluster transported to hospital prior to return of spontaneous circulation, examined as quartiles and as a continuous variable. Multilevel mixed-effects logistic regression modeling estimated the association between regional IAT with survival to hospital discharge and favorable neurologic status (modified Rankin Scale ≤ 3) at hospital discharge. RESULTS Of 26,148 subjects (median age 68 years; 36% female; 23% shockable initial rhythm) 2424 (9.3%), survived to hospital discharge and 1993 (7.6%) had favourable neurological outcomes. Across regional clusters, IAT ranged from 0.84% to 75% (quartiles <6.2%, 6.2-19.6%, 19.6-30.4%, and ≥30.4%). For each quartile, 13.3%, 7.9%, 7.4%, and 4.8% survived, and 10.4%, 7.8%, 7.4%, and 4.8% had favourable neurological status. Regional IAT (per 10% change) was associated with decreased probability of survival (AOR 0.86, 95% CI 0.82-0.91) and favorable neurological outcome (AOR 0.80, 95% CI 0.76-0.85). CONCLUSION Treatment within a region that utilizes IAT less frequently was associated with improved clinical outcomes at hospital discharge. These findings may account for some of the known regional variation in OHCA outcomes.
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Affiliation(s)
- Brian Grunau
- Centre for Health Evaluation and Outcome Sciences and the BC Resuscitation Research Collaborative, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Vancouver, British Columbia, Canada.
| | - Takahisa Kawano
- The Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan
| | - Thomas D Rea
- Department of Medicine, University of Washington, WA, USA
| | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, PA, USA
| | - Frank X Scheuermeyer
- Centre for Health Evaluation and Outcome Sciences and the BC Resuscitation Research Collaborative, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada
| | - Joshua C Reynolds
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Matthieu Heidet
- Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, University Hospital Henri Mondor, Créteil, France; University Paris-Est Créteil (UPEC), EA-4390 (ARCHeS), Créteil, France
| | - Ian R Drennan
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Sunnybrook Centre for Prehospital Medicine and the University of Toronto, Canada
| | - Sheldon Cheskes
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Sunnybrook Centre for Prehospital Medicine and the University of Toronto, Canada
| | - Christopher B Fordyce
- Centre for Health Evaluation and Outcome Sciences and the BC Resuscitation Research Collaborative, St. Paul's Hospital, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, British Columbia, Canada
| | - Brian Twaites
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences and the BC Resuscitation Research Collaborative, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada
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Park JH, Choi J, Lee S, Shin SD, Song KJ. Use of Time-to-Event Analysis to Develop On-Scene Return of Spontaneous Circulation Prediction for Out-of-Hospital Cardiac Arrest Patients. Ann Emerg Med 2021; 79:132-144. [PMID: 34417073 DOI: 10.1016/j.annemergmed.2021.07.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE We aimed to train and validate the time to on-scene return of spontaneous circulation prediction models using time-to-event analysis among out-of-hospital cardiac arrest patients. METHODS Using a Korean population-based out-of-hospital cardiac arrest registry, we selected a total of 105,215 adults with presumed cardiac etiologies between 2013 and 2018. Patients from 2013 to 2017 and from 2018 were analyzed for training and test, respectively. We developed 4 time-to-event analyzing models (Cox proportional hazard [Cox], random survival forest, extreme gradient boosting survival, and DeepHit) and 4 classification models (logistic regression, random forest, extreme gradient boosting, and feedforward neural network). Patient characteristics and Utstein elements collected at the scene were used as predictors. Discrimination and calibration were evaluated by Harrell's C-index and integrated Brier score. RESULTS Among the 105,215 patients (mean age 70 years and 64% men), 86,314 and 18,901 patients belonged to the training and test sets, respectively. On-scene return of spontaneous circulation was achieved in 5,240 (6.1%) patients in the former set and 1,709 (9.0%) patients in the latter. The proportion of emergency medical services (EMS) management was higher and scene time interval longer in the latter. Median time from EMS scene arrival to on-scene return of spontaneous circulation was 8 minutes for both datasets. Classification models showed similar discrimination and poor calibration power compared to survival models; Cox showed high discrimination with the best calibration (C-index [95% confidence interval]: 0.873 [0.865 to 0.882]; integrated Brier score at 30 minutes: 0.060). CONCLUSION Incorporating time-to-event analysis could lead to improved performance in prediction models and contribute to personalized field EMS resuscitation decisions.
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Affiliation(s)
- Jeong Ho Park
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jinwook Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea; Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.
| | - SangMyeong Lee
- School of Electrical Engineering, Undergraduate School of Korea University, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, Korea
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Urban S, Carmichael H, Moe M, Kramer A, Al-Azzawi O, Dumond R, Wright A, McIntyre R, Velopulos C. The Critical Intervention Screen: A Novel Tool to Determine the use of Lights and Sirens During the Transport of Trauma Patients. PREHOSP EMERG CARE 2021; 26:566-572. [PMID: 34313543 DOI: 10.1080/10903127.2021.1961040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: EMS use of lights and sirens has long been employed in EMS systems, despite an increased risk of motor vehicle collisions associated with their use. The specific aims of this study were to assess the current use of lights and sirens during the transport of trauma patients in a busy metropolitan area and to subsequently develop a novel tool, the Critical Intervention Screen, to aid EMS professionals tasked with making transport decisions in the presence of acute injury.Methods: This single-center, retrospective study included all patients transported to an academic Level One trauma center by ground ambulance from the scene of presumed or known injury. A subset of patients was identified as being most likely to benefit from shorter transport times if they received one of the following critical interventions within 20 minutes of emergency department arrival: intubation, thoracotomy, chest tube, blood products, central line, arterial line, REBOA, disposition to an operating room, or death. Stepwise logistic regression was employed for the development of the Critical Intervention Screen, with a subset of data retained for internal validation.Results: 1296 patients were available for analysis. Overall, 217 patients (16.7%) received a critical intervention, and 112 patients (8.6%) of those patients received a critical intervention within 20 minutes of emergency department arrival. At baseline, EMS use of lights and sirens was 91.1% sensitive and 80.3% specific for receiving a critical intervention. Stepwise logistic regression demonstrated that the need for assisted ventilation, GCS Motor <6, and penetrating trauma to the trunk were the most predictive prehospital data for receiving at least one critical intervention. The Critical Intervention Screen, defined as having at least one of these risk factors in the prehospital setting, modestly increased sensitivity and specificity (96.4% and 87.9%, respectively) predicting the need for a critical intervention.Conclusion: These findings indicate that EMS are able to correctly identify high-acuity trauma patients, but at times employ L&S during the transport of patients with a low likelihood of receiving a time-sensitive intervention upon emergency department arrival. Therefore, the Critical Intervention Screen has the potential to reduce the use of lights and sirens and improve EMS safety.
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Affiliation(s)
- Shane Urban
- Department of Trauma Services, UCHealth University of Colorado Hospital, Aurora, USA
| | - Heather Carmichael
- Department of Trauma and Acute Care Surgery, University of Colorado, Aurora, USA
| | - Martin Moe
- Department of Trauma Services, UCHealth University of Colorado Hospital, Aurora, USA
| | - Andrea Kramer
- Department of Trauma Services, UCHealth University of Colorado Hospital, Aurora, USA
| | - Omar Al-Azzawi
- Department of Trauma Services, UCHealth University of Colorado Hospital, Aurora, USA
| | - Robbie Dumond
- Department of Trauma Services, UCHealth University of Colorado Hospital, Aurora, USA
| | - Angela Wright
- Department of Trauma and Acute Care Surgery, University of Colorado, Aurora, USA
| | - Robert McIntyre
- Department of Trauma and Acute Care Surgery, University of Colorado, Aurora, USA
| | - Catherine Velopulos
- Department of Trauma and Acute Care Surgery, University of Colorado, Aurora, USA
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Lerner EB, Browne LR, Studnek JR, Mann NC, Dai M, Hoffman CK, Pilkey D, Adelgais KM, Brown KM, Gaither JB, Leonard JC, Martin-Gill C, Nishijima DK, Owusu Ansah S, Shah ZS, Shah MI. A Novel Use of NEMSIS to Create a PECARN-Specific EMS Patient Registry. PREHOSP EMERG CARE 2021; 26:484-491. [PMID: 34232828 DOI: 10.1080/10903127.2021.1951407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Research networks need access to EMS data to conduct pilot studies and determine feasibility of prospective studies. Combining data across EMS agencies is complicated and costly. Leveraging the National EMS Information System (NEMSIS) to extract select agencies' data may be an efficient and cost-effective method of providing network-level data. Objective: Describe the process of creating a Pediatric Emergency Care Applied Research Network (PECARN) specific NEMSIS data set and determine if these data were nationally representative. Methods: We established data use agreements (DUAs) with EMS agencies participating in PECARN to allow for agency identification through NEMSIS. Using 2019 NEMSIS version 3.4.0 data for EMS events with patients 18 years old and younger, we compared PECARN NEMSIS data to national NEMSIS data. Analyzed variables were selected for their ability to characterize events. No statistical analyses were utilized due to the large sample, instead, differences of ±5% were deemed clinically meaningful. Results: DUAs were established for 19 EMS agencies, creating a PECARN data set with 305,188 EMS activations of which 17,478 (5.7%) were pediatric. Of the pediatric activations, 17,140 (98.1%) were initiated through 9-1-1 and 9,487 (55.4%) resulted in transport by the documenting agency. The national data included 36,288,405 EMS activations of which 2,152,849 (5.9%) were pediatric. Of the pediatric activations 1,704,141 (79.2%) were initiated through 9-1-1 and 1,055,504 (61.9%) were transported by the documenting agency. Age and gender distributions were similar between the two groups, but the PECARN-specific data under-represents Black and Latinx patients. Comparison of EMS provider primary impressions revealed that three of the five most common were similar with injury being the most prevalent for both data sets along with mental/behavioral health and seizure. Conclusion: We demonstrated that NEMSIS can be leveraged to create network specific data sets. PECARN's EMS data were similar to the national data, though racial/ethnic minorities and some primary impressions may be under-represented. Additionally, more EMS activations in PECARN study areas originated through 9-1-1 but fewer were transported by the documenting agency. This is likely related to the type of participating agencies, their ALS response level, and the diversity of the communities they serve.
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Vuorinen PET, Ollikainen JPJ, Ketola PA, Vuorinen RLK, Setälä PA, Hoppu SE. Emergency medical dispatchers' ability to identify large vessel occlusion stroke during emergency calls. Scand J Trauma Resusc Emerg Med 2021; 29:97. [PMID: 34281596 PMCID: PMC8287663 DOI: 10.1186/s13049-021-00914-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background In acute ischemic stroke, conjugated eye deviation (CED) is an evident sign of cortical ischemia and large vessel occlusion (LVO). We aimed to determine if an emergency dispatcher can recognise LVO stroke during an emergency call by asking the caller a binary question regarding whether the patient’s head or gaze is away from the side of the hemiparesis or not. Further, we investigated if the paramedics can confirm this sign at the scene. In the group of positive CED answers to the emergency dispatcher, we investigated what diagnoses these patients received at the emergency department (ED). Among all patients brought to ED and subsequently treated with mechanical thrombectomy (MT) we tracked the proportion of patients with a positive CED answer during the emergency call. Methods We collected data on all stroke dispatches in the city of Tampere, Finland, from 13 February 2019 to 31 October 2020. We then reviewed all patient records from cases where the dispatcher had marked ‘yes’ to the question regarding patient CED in the computer-aided emergency response system. We also viewed all emergency department admissions to see how many patients in total were treated with MT during the period studied. Results Out of 1913 dispatches, we found 81 cases (4%) in which the caller had verified CED during the emergency call. Twenty-four of these patients were diagnosed with acute ischemic stroke. Paramedics confirmed CED in only 9 (11%) of these 81 patients. Two patients with positive CED answers during the emergency call and 19 other patients brought to the emergency department were treated with MT. Conclusion A small minority of stroke dispatches include a positive answer to the CED question but paramedics rarely confirm the emergency medical dispatcher’s suspicion of CED as a sign of LVO. Few patients in need of MT can be found this way. Stroke dispatch protocol with a CED question needs intensive implementation.
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Affiliation(s)
- Pauli E T Vuorinen
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Hospital District, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland.
| | - Jyrki P J Ollikainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Pasi A Ketola
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Hospital District, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
| | | | - Piritta A Setälä
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Hospital District, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
| | - Sanna E Hoppu
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa Hospital District, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
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Abstract
The role of air medical and land-based critical care transport services is not always clear amongst traditional emergency medical service providers or hospital-based health care practitioners. Some of this is historical, when air medical services were in their infancy and their role within the broader health care system was limited. Despite their evolution within the regionalized health care system, some myths remain regarding air medical services in Canada. The goal is to clarify several commonly held but erroneous beliefs regarding the role, impact, and practices in air medical transport.
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Fifty Years of Progress in Neonatal and Maternal Transport for Specialty Care. J Obstet Gynecol Neonatal Nurs 2021; 50:774-788. [PMID: 34166650 DOI: 10.1016/j.jogn.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
Specialty care for preterm and critically ill infants has evolved over many years. Neonatal intensive care nurseries were developed, and physicians and nurses learned how to provide intensive care for these infants. Neonatal and maternal (in utero) transport to tertiary centers became common in regionalized systems of care to facilitate the specialized care of high-risk neonates when childbirth occurred in settings without specialized personnel or equipment. Annually, nearly 70,000 neonatal transports occur in the United States. Although specialty care helps reduce rates of neonatal mortality, racial disparities and disparities between urban and rural areas exist. The purpose of this article is to review the progress achieved in neonatal and maternal transport over the past 50 years. The knowledge developed can be used to improve the care provided to women, their fetuses, and infants.
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Afshari A, Borzou SR, Shamsaei F, Mohammadi E, Tapak L. Perceived occupational stressors among emergency medical service providers: a qualitative study. BMC Emerg Med 2021; 21:35. [PMID: 33757433 PMCID: PMC7988920 DOI: 10.1186/s12873-021-00430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Emergency medical services (EMS) providers are at continuous exposure to occupational stressors which negatively affect their health and professional practice. This study explored perceived occupational stressors among EMS providers. Methods This qualitative study was conducted from December 2019 to April 2020 using conventional content analysis. Sixteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. Semi-structured interviews (with length of 45–60 min) were held for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach. Findings Data analysis resulted in the development of two themes, namely critical conditions of EMS provision, and personal and professional conflicts. The six categories of these two themes were complexity of patients’ clinical conditions, interruption of EMS provision, health hazards, interpersonal problems, interprofessional interactions, and legal conflicts. Conclusion Besides the stress associated with emergency patient care, EMS providers face many different occupational stressors. EMS managers can use the findings of the present study to develop strategies for reducing occupational stress among EMS providers and thereby, improve their health and care quality.
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Affiliation(s)
- Ali Afshari
- Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Reza Borzou
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Farshid Shamsaei
- Maternal and Child Care Research Center,Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Eesa Mohammadi
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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The Safety and Utility of Ground Transport of Traumatic Cardiopulmonary Arrest Patients by Helicopter Emergency Medical Services Crews. Air Med J 2021; 40:108-111. [PMID: 33637272 DOI: 10.1016/j.amj.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients suffering from traumatic cardiopulmonary arrest (TCPA) typically demonstrate dismal survival rates. Some helicopter emergency medical services (HEMS) systems transport TCPA patients via ground with a referring agency when cardiopulmonary pulmonary resuscitation is in progress. With expanding research on the inherent risk of ground emergency medical services (GEMS) transport with the use of lights and sirens to both crew and the general public, the benefits may not outweigh the risks of transporting these patients by GEMS. The aim of this study was to determine the number of TCPA patients transported by GEMS with HEMS crews on board who survived to hospital discharge. METHODS A retrospective chart review was performed of approximately 10 years of data from a regional Midwest HEMS service. Survival to hospital discharge was the primary outcome. RESULTS Flight crews transported 54 patients via ambulance with GEMS crews; 31 patients met all inclusion and exclusion criteria. Of the 31 patients transported, 0 survived to hospital discharge. CONCLUSION Based on our 0% survival rate and the inherent risk of injury and death to emergency medical services crews and the general public, the risk of transporting adult TCPA patients by GEMS using lights and sirens outweighs the benefit.
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Evans CCD, Li W, Seitz D. Injury-related deaths in the Ontario provincial trauma system: a retrospective population-based cohort analysis. CMAJ Open 2021; 9:E208-E214. [PMID: 33688029 PMCID: PMC8034298 DOI: 10.9778/cmajo.20200209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although Ontario has an established trauma system, it experiences a substantial burden of morbidity and mortality from injury. Our objective was to describe patterns of fatal injury in Ontario, with a focus on location of death (out of hospital, trauma or non-trauma centre) and receipt of surgical intervention before death. METHODS We conducted a retrospective population-based cohort study using linked administrative data on fatal injuries in children and adults (no age restrictions) in Ontario between 2000 and 2016. We identified injury-related deaths in the Ontario Registrar General Death database. We developed descriptive statistics for injury characteristics and causes of death. We calculated the fatal injury incidence rate for each year of the study. The primary outcome was cause of death; the secondary outcome was receipt of surgical intervention. RESULTS The analysis included 19 408 people. The mean annual incidence of fatal injury averaged 8.7 (95% confidence interval 7.7-9.6) per 100 000. The most common mechanisms of injury were motor vehicle collisions (12 065, 62.2%), followed by gunshot wounds (3134, 16.1%) and falls (2387, 12.3%). Deaths frequently occurred out of hospital (72.6%), rather than at a trauma centre (14.2%) or non-trauma centre (13.2%). Patients treated at trauma centres were significantly more likely to receive a surgical intervention (standardized difference 0.6) than those treated at non-trauma centres. INTERPRETATION Most injury deaths in Ontario occur in the out-of-hospital setting or are managed at non-trauma centres; many patients receive no surgical intervention before death. There are likely opportunities to improve access to specialized injury care in Ontario's trauma system.
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Affiliation(s)
- Christopher C D Evans
- Department of Emergency Medicine (Evans), Queen's University; ICES Queen's (Evans, Li), Kingston, Ont.; Department of Psychiatry (Seitz), University of Calgary, Calgary, Alta.
| | - Wenbin Li
- Department of Emergency Medicine (Evans), Queen's University; ICES Queen's (Evans, Li), Kingston, Ont.; Department of Psychiatry (Seitz), University of Calgary, Calgary, Alta
| | - Dallas Seitz
- Department of Emergency Medicine (Evans), Queen's University; ICES Queen's (Evans, Li), Kingston, Ont.; Department of Psychiatry (Seitz), University of Calgary, Calgary, Alta
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Grunau B, Kime N, Leroux B, Rea T, Van Belle G, Menegazzi JJ, Kudenchuk PJ, Vaillancourt C, Morrison LJ, Elmer J, Zive DM, Le NM, Austin M, Richmond NJ, Herren H, Christenson J. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. JAMA 2020; 324:1058-1067. [PMID: 32930759 PMCID: PMC7492914 DOI: 10.1001/jama.2020.14185] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Importance There is wide variability among emergency medical systems (EMS) with respect to transport to hospital during out-of-hospital cardiac arrest (OHCA) resuscitative efforts. The benefit of intra-arrest transport during resuscitation compared with continued on-scene resuscitation is unclear. Objective To determine whether intra-arrest transport compared with continued on-scene resuscitation is associated with survival to hospital discharge among patients experiencing OHCA. Design, Setting, and Participants Cohort study of prospectively collected consecutive nontraumatic adult EMS-treated OHCA data from the Resuscitation Outcomes Consortium (ROC) Cardiac Epidemiologic Registry (enrollment, April 2011-June 2015 from 10 North American sites; follow-up until the date of hospital discharge or death [regardless of when either event occurred]). Patients treated with intra-arrest transport (exposed) were matched with patients in refractory arrest (at risk of intra-arrest transport) at that same time (unexposed), using a time-dependent propensity score. Subgroups categorized by initial cardiac rhythm and EMS-witnessed cardiac arrests were analyzed. Exposures Intra-arrest transport (transport initiated prior to return of spontaneous circulation), compared with continued on-scene resuscitation. Main Outcomes and Measures The primary outcome was survival to hospital discharge, and the secondary outcome was survival with favorable neurological outcome (modified Rankin scale <3) at hospital discharge. Results The full cohort included 43 969 patients with a median age of 67 years (interquartile range, 55-80), 37% were women, 86% of cardiac arrests occurred in a private location, 49% were bystander- or EMS-witnessed, 22% had initial shockable rhythms, 97% were treated by out-of-hospital advanced life support, and 26% underwent intra-arrest transport. Survival to hospital discharge was 3.8% for patients who underwent intra-arrest transport and 12.6% for those who received on-scene resuscitation. In the propensity-matched cohort, which included 27 705 patients, survival to hospital discharge occurred in 4.0% of patients who underwent intra-arrest transport vs 8.5% who received on-scene resuscitation (risk difference, 4.6% [95% CI, 4.0%- 5.1%]). Favorable neurological outcome occurred in 2.9% of patients who underwent intra-arrest transport vs 7.1% who received on-scene resuscitation (risk difference, 4.2% [95% CI, 3.5%-4.9%]). Subgroups of initial shockable and nonshockable rhythms as well as EMS-witnessed and unwitnessed cardiac arrests all had a significant association between intra-arrest transport and lower probability of survival to hospital discharge. Conclusions and Relevance Among patients experiencing out-of-hospital cardiac arrest, intra-arrest transport to hospital compared with continued on-scene resuscitation was associated with lower probability of survival to hospital discharge. Study findings are limited by potential confounding due to observational design.
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Affiliation(s)
- Brian Grunau
- Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Noah Kime
- Department of Medicine, University of Washington, Seattle
| | - Brian Leroux
- Department of Medicine, University of Washington, Seattle
| | - Thomas Rea
- Department of Medicine, University of Washington, Seattle
| | | | - James J. Menegazzi
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Laurie J. Morrison
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nancy M. Le
- Oregon Health and Science University, Portland
| | - Michael Austin
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Neal J. Richmond
- Metropolitan Area EMS Authority/Emergency Physicians Advisory Board, Ft Worth, Texas
| | - Heather Herren
- Department of Medicine, University of Washington, Seattle
| | - Jim Christenson
- Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
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Jarvis JL, Hamilton V, Taigman M, Brown LH. Using Red Lights and Sirens for Emergency Ambulance Response: How Often Are Potentially Life-Saving Interventions Performed? PREHOSP EMERG CARE 2020; 25:549-555. [PMID: 32678993 DOI: 10.1080/10903127.2020.1797963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Emergency Medical Services (EMS) often respond to 911 calls using red lights and sirens (RLS). RLS is associated with increased collisions and increased injuries to EMS personnel. While some patients might benefit from time savings, there is little evidence to guide targeted RLS response strategies. OBJECTIVE To describe the frequency and nature of 911 calls that result in potentially life-saving interventions (PLSI) during the call. METHODS Using data from ESO (Austin, Texas, USA), a national provider of EMS electronic health records, we analyzed all 911 calls in 2018. We abstracted the use of RLS, call nature, and interventions performed. A liberal definition of PLSI was developed a priori through a consensus process and included both interventions, medications, and critical hospital notifications. We calculated the proportion of calls with RLS response and with PLSI performed, both overall and stratified by call nature. RESULTS There were 5,977,612 calls from 1,187 agencies included in the analysis. The majority (85.8%) of calls utilized RLS, yet few (6.9%) resulted in PLSI. When stratified by call nature, cardiac arrest calls had the highest frequency PLSI (45.0%); followed by diabetic problems (37.0%). Glucose was the most frequently given PLSI, n = 69,036. When including multiple administrations to the same patient, epinephrine was given most commonly PLSI, n = 157,282 administrations). CONCLUSION In this large national dataset, RLS responses were very common (86%) yet potentially life-saving interventions were infrequent (6.9%). These data suggest a methodology to help EMS leaders craft targeted RLS response strategies.
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Axelrod DA, Shah S, Guarrera J, Shepard B, Scalea J, Cooper M, Kandaswamy R. Improving safety in organ recovery transportation: Report from the ASTS/UNOS/AST/AOPO transportation safety summit. Am J Transplant 2020; 20:2001-2008. [PMID: 32320532 DOI: 10.1111/ajt.15930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 01/25/2023]
Abstract
Despite the passage of a decade since the tragic loss of an organ recovery team from the University of Michigan, there are currently no national standards governing air and ground transportation of organ recovery personnel. Consequently, the American Society of Transplant Surgeons, the Association of Organ Procurement Organizations, and the United Network for Organ Sharing jointly convened a transportation summit to review and update recommendations for national transportation standards. Expanded air transport quality assurance protocols, including a requirement for two engine turbine-powered aircraft piloted by two qualified pilots certified through onsite inspections was recommended. Ground transportation providers must ensure adequate safety restraints are available, ambulance avoided if possible, and the use of lights and sirens minimized. Finally, adequate insurance coverage for all team members, including trainees should be provided and should not rely on carrier liability insurance policies. The summit participants have committed the support of their organizations to promote and enact these regulations nationally.
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Affiliation(s)
| | - Shimul Shah
- University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Brian Shepard
- United Network for Organ Sharing, Richmond, Virginia, USA
| | | | - Mathew Cooper
- Medstar-Georgetown University, Washington, District of Columbia, USA
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Jansson PS, Richards JB, Frakes MA, Cohen JE, Wilcox SR. The Effect of Lights and Sirens on Critical Care Transport Time. J Emerg Med 2020; 59:553-560. [PMID: 32741576 DOI: 10.1016/j.jemermed.2020.06.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the prehospital setting, the use of ambulance lights and sirens (L&S) has been found to result in minor decreases in transport times, but has not been studied in interfacility transportation. OBJECTIVE The objective of this study was to evaluate the indications for L&S and the impact of L&S on transport times in interfacility critical care transport. METHODS We performed a retrospective analysis using administrative data from a large, urban critical care transportation organization. The indications for L&S were assessed and the transport times with and without L&S were compared using distance matching for common transport routes. Median times were compared for temporal subgroups. RESULTS L&S were used in 7.3% of transports and were most strongly associated with transport directly to the operating room (odds ratio 15.8; 95% confidence interval 6.32-39.50; p < 0.001). The timing of the transport was not associated with L&S use. For all transports, there was a significant decrease in the transport time using L&S, with a median of 8 min saved, corresponding to 19.5% of the overall transportation time without L&S (33 vs. 41 min; p < 0.001). The reduction in transport times was consistent across all temporal subgroups, with a greater time reduction during rush hour transports. CONCLUSIONS The use of L&S during interfacility critical care transport was associated with a statistically significant time reduction in this urban, single-system retrospective analysis. Although the use of L&S was not associated with rush-hour transports, the greatest time reduction was associated with L&S transport during these hours.
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Affiliation(s)
- Paul S Jansson
- Division of Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jeremy B Richards
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Jason E Cohen
- Boston MedFlight, Bedford, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Boston MedFlight, Bedford, Massachusetts; Division of Critical Care Medicine, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Miller ML, Lincoln EW, Brown LH. Development of a Binary End-of-Event Outcome Indicator for the NEMSIS Public Release Research Dataset. PREHOSP EMERG CARE 2020; 25:504-511. [PMID: 32658624 DOI: 10.1080/10903127.2020.1794435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Emergency department and hospital discharge status are available for less than 2% of events recorded in the National EMS Information System (NEMSIS) Public Release Research dataset. The purpose of this project was to develop a binary ("dead" vs. "alive") end-of-event outcome indicator for the NEMSIS dataset. METHODS The data dictionary for the Version 3 NEMSIS dataset was evaluated to identify elements and codes providing information about a patient's end-of-event status-defined as the point at which EMS providers stopped providing care for an encountered patient, whether at the scene of the event or the transport destination. Those element and code combinations were then used to test the criteria using the NEMSIS-2017 dataset. After revising the criteria based on the NEMSIS-2017 results, the final criteria were then applied to the 2018 NEMSIS dataset. To assess representativeness, the characteristics of events with a determinable outcome were compared to those of the entire dataset. To assess accuracy, the end-of-event indicator was compared with the final reported outcome for patients with a known emergency department disposition. RESULTS Eighteen NEMSIS element and code combinations suggest a patient was likely "dead" at the end of EMS care, and 15 combinations suggest a patient was likely "alive" at the end of EMS care. A binary end-of-event outcome indicator could be determined for 13,045,887 (98.6%) of the 13,229,079 NEMSIS-2018 9-1-1 initiated ground EMS responses in which patient contact was established, and for 132,728 (89.1%) of the 148,963 events with documented cardiac arrest. The characteristics of the events with determinable end-of-event outcomes did not differ from those of the full dataset. Among patients with a known outcome, 99.6% of those with an "alive" end-of-event indicator were in fact alive at the time of emergency department disposition. CONCLUSION A binary end-of-event outcome indicator can be determined for 98.6% of 9-1-1 initiated ground EMS scene responses and 89.1% of cardiac arrests included in the NEMSIS dataset. The events with a determinable outcome appear representative of the larger dataset and the end-of-event indicators are generally consistent with reported emergency department outcomes.
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Affiliation(s)
- Melissa L Miller
- Received May 26, 2020 from Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas (MLM, EWL, LHB). Revision received June 22, 2020; accepted July 6, 2020
| | - Erin W Lincoln
- Received May 26, 2020 from Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas (MLM, EWL, LHB). Revision received June 22, 2020; accepted July 6, 2020
| | - Lawrence H Brown
- Received May 26, 2020 from Division of Emergency Medicine, Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas (MLM, EWL, LHB). Revision received June 22, 2020; accepted July 6, 2020
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Reid BO, Haugland H, Abrahamsen HB, Bjørnsen LP, Uleberg O, Krüger AJ. Prehospital Stressors: A Cross-sectional Study of Norwegian Helicopter Emergency Medical Physicians. Air Med J 2020; 39:383-388. [PMID: 33012477 DOI: 10.1016/j.amj.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Personnel working in helicopter emergency medical services (HEMS) and search and rescue (SAR) are exposed to environmental stressors, which may impair performance. The aim of this survey was to study the extent HEMS and SAR physicians report the influence of specific danger-based and non-danger-based stressors. METHODS The study was performed as a cross-sectional, anonymous, Web-based (Questback AS, Bogstadveien 54, 0366 Oslo, Norway) survey of Norwegian HEMS and SAR physicians between December 2, 2019, and February 25, 2020. RESULTS Of the recipients, 119 (79.3%) responded. In helicopter operations, 33.6% (n = 40) reported involvement in a minor accident and 44.5% (n = 53) a near accident. In the rapid response car, 26.1% (n = 31) reported near accidents, whereas 26.9% (32) reported this in an ambulance. Of physicians, 20.2% (n = 24) received verbal abuse or threats during the last 12 months. When on call, 50.4% (n = 60) of physicians reported sometimes or often being influenced by fatigue. CONCLUSION This study shows that Norwegian HEMS and SAR physicians are exposed to several stressors of both a danger-based and non-danger-based nature, especially regarding accidents, threatening patient behavior, and fatigue. Very serious incidents appear to be seldom, and job satisfaction is high.
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Affiliation(s)
- Bjørn Ole Reid
- Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim, Norway; Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway.
| | - Helge Haugland
- Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim, Norway; Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Håkon Bjorheim Abrahamsen
- Institute for Safety, Economics and Planning, University of Stavanger, Norway; Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Lars Petter Bjørnsen
- Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim, Norway; Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Andreas J Krüger
- Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim, Norway; Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
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Ceklic E, Tohira H, Ball S, Brown E, Brink D, Bailey P, Whiteside A, Finn J. Motor Vehicle Crash Characteristics That Are Predictive of High Acuity Patients: An Analysis of Linked Ambulance and Crash Data. PREHOSP EMERG CARE 2020; 25:351-360. [DOI: 10.1080/10903127.2020.1771487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Decreasing Usage of Lights and Sirens in an Urban Environment: A Quality Improvement Project. Pediatr Qual Saf 2020; 5:e279. [PMID: 32426642 PMCID: PMC7190247 DOI: 10.1097/pq9.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/06/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction The risk of lights and sirens use in emergency medical services has been well documented. Our critical care transport team performs over 1,800 interfacility nonemergency medical services transports annually into a dense urban environment. Historically, we have utilized lights and sirens to navigate traffic patterns. The use exceeded industry standards. This quality improvement project was undertaken to decrease the use of lights and sirens. Methods/Results The baseline use of lights and sirens in 2011 was 76% en route and 73% on return to the facility. We revised the internal policy guiding the appropriate usage of lights and sirens. In 2012, without an improvement in usage, a use justification process was implemented. By 2013, the use of lights and sirens was still high en route, but had decreased to 53% on the return trip. In 2014, we added accountability measures requiring justification, with a subsequent drop in 2015 to 14% en route and 13% on return. In the following 3 years, the transport teams have sustained lights and sirens use to 20% or below. Conclusions This quality improvement initiative impacted team behavior and decreased the use of lights and sirens over 5 years, with sustained improvement at or below 20%. This improvement was accomplished through ongoing evaluation, education, data gathering, and open communication. There was no negative impact on patient outcomes during this time. Lights and sirens continue to be used when indicated.
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Lights and Siren Transport and the Need for Hospital Intervention in Nontrauma Patients: A Prospective Study. Emerg Med Int 2020; 2020:2651624. [PMID: 32257445 PMCID: PMC7102462 DOI: 10.1155/2020/2651624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/19/2020] [Indexed: 01/01/2023] Open
Abstract
Background The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field, fast-track, is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. The aim of this study was to determine whether the use of LST was associated with the realization of TCHI for nontrauma cases within 15 minutes of hospital arrival, to quantify overtriage (LST without TCHI) and to identify the predictors of TCHI. Methods This is a monocentric prospective observational study of nontrauma patients transported by ambulance. Based on Ross et al.'s work in 2016 on trauma patients, TCHI procedures were developed by the study team. Descriptive statistics were used to determine whether the use of LST was associated with the realization of TCHI. Multivariable analyses determined the predictors of TCHI and compared clinical outcomes. Results On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI (p < 0.001). The overtriage rate was 40.3%. The most common medical TCHI was the fast-track (65.2% of all TCHI). LST was predictive of the need for TCHI (p < 0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI. Conclusions A majority of the LST benefitted from TCHI with an overtriage rate of 40%. To reduce the rate of overtriage (LST without TCHI), LST should mainly be used for fast-track and when TCHI is expected by the EMS providers.
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Lights and Siren: A Risky Business? Ann Emerg Med 2019; 74:110-111. [DOI: 10.1016/j.annemergmed.2019.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 11/27/2022]
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