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Burton E, Quinn R, Crosbie-Staunton K, Deasy C, Masterson S, O'Donnell C, Merwick Á, Willis D, Kearney PM, Mc Carthy VJC, Buckley CM. Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study. BMJ Open 2024; 14:e078168. [PMID: 38508613 PMCID: PMC10961584 DOI: 10.1136/bmjopen-2023-078168] [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: 07/26/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Time is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021. DESIGN We conducted a secondary data analysis with a quasi-experimental design. SETTING We used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as '1 March 2020-31 December 2021' and the pre-COVID-19 period '1 January 2018-29 February 2020'. PRIMARY AND SECONDARY OUTCOME MEASURES We compared five ambulance time intervals: 'allocation performance', 'mobilisation performance', 'response time', 'on scene time' and 'conveyance time' between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis. PARTICIPANTS We included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021. RESULTS 40 004 cases were included: 19 826 in the pre-COVID-19 period and 19 731 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001). CONCLUSIONS A 'shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork, Ireland
| | - Rory Quinn
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | | | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Áine Merwick
- Neurology Department, Cork University Hospital, Cork, Ireland
| | - David Willis
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Hutin A, Ricard-Hibon A, Briole N, Dupin A, Dagron C, Raphalen JH, Mungur A, An K, Carli P, Lamhaut L. First Description of a Helicopter-Borne ECPR Team for Remote Refractory Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2021:1-5. [PMID: 33275477 DOI: 10.1080/10903127.2020.1859026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/10/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
Introduction: Access time to extracorporeal cardiopulmonary resuscitation (ECPR) refractory out of hospital cardiac arrest (OHCA) is a crucial factor. In our region, some patients are not eligible to this treatment due to the impossibility to reach the hospital with reasonable delay (ideally 60 min). In order to increase accessibility for patients far from ECPR centers, we developed a helicopter-borne ECPR-team which is sent out to the patient for ECPR implementation on the scene of the OHCA.Methods: We conducted a retrospective monocentric study to evaluate this strategy. The team is triggered by the local emergency medical service and heliborne on the site of the OHCA. All consecutive patients implemented with ECPR by our heliborne ECPR team from January 2014 to December 2017 were included. We analyzed usual CA characteristics, different times (no-flow, low-flow, time between OHCA and dispatch…), and patient outcome.Results: During this 4-year study period, 33 patients were included. Mean age was 43.9 years. Mean distance from the ECPR-team base to OHCA location was 41 km. Mean low-flow time was 110 minutes. Five patients survived with good neurological outcome; 6 patients developed brain death and became organ donors.Conclusion: These results show the possibility to make ECPR accessible for patients far from ECPR centers. Survival rate is non negligible, especially in the absence of therapeutic alternative. An earlier trigger of the ECPR-team could reduce the low-flow time and probably increase survival. This strategy improves equity of access to ECPR and needs to be confirmed by further studies.
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Affiliation(s)
- A Hutin
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - A Ricard-Hibon
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - N Briole
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - A Dupin
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - C Dagron
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - J H Raphalen
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - A Mungur
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - K An
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - P Carli
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
| | - L Lamhaut
- SAMU de Paris-ICU, Necker University Hospital, Assistance publique-Hopitaux de Paris, Paris, France (AH, CD, JHR, AM, KA, PC, LL); INSERM U955, Equipe 3, École Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Paris, France (AH); SAMU-SMUR 95, Centre Hospitalier René Dubois, Pontoise, France (AR-H); SAMU-SMUR 77, Centre Hospitalier Marc Jaquet, Melun, France (NB); SAMU-SMUR 91, Centre Hospitalier Sud Francilien, Corbeil-Essones, France (AD); René Descartes University, Paris, France (PC, LL); INSERM U970, Unité 4 SDEC, Paris, France (LL)
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Cabral ELDS, Castro WRS, Florentino DRDM, Viana DDA, Costa Junior JFD, Souza RPD, Rêgo ACM, Araújo-Filho I, Medeiros AC. Response time in the emergency services. Systematic review. Acta Cir Bras 2019; 33:1110-1121. [PMID: 30624517 DOI: 10.1590/s0102-865020180120000009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/03/2018] [Indexed: 11/22/2022] Open
Abstract
The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.
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Affiliation(s)
- Eric Lucas Dos Santos Cabral
- Fellow Master degree, Postgraduate Program in Production Engineering, Universidade Federal do Rio Grande do Norte (UFRN), Natal-RN, Brazil. Acquisition, interpretation and analysis of data; manuscript writing
| | - Wilkson Ricardo Silva Castro
- Fellow Master degree, Postgraduate Program in Production Engineering, Universidade Federal do Rio Grande do Norte (UFRN), Natal-RN, Brazil. Acquisition, interpretation and analysis of data; manuscript writing
| | - Davidson Rogério de Medeiros Florentino
- Fellow Master degree, Postgraduate Program in Production Engineering, Universidade Federal do Rio Grande do Norte (UFRN), Natal-RN, Brazil. Acquisition, interpretation and analysis of data; manuscript writing
| | - Danylo de Araújo Viana
- Fellow Master degree, Postgraduate Program in Production Engineering, Universidade Federal do Rio Grande do Norte (UFRN), Natal-RN, Brazil. Acquisition, interpretation and analysis of data; manuscript writing
| | - João Florêncio da Costa Junior
- Fellow Master degree, Postgraduate Program in Production Engineering, Universidade Federal do Rio Grande do Norte (UFRN), Natal-RN, Brazil. Acquisition, interpretation and analysis of data; manuscript writing
| | - Ricardo Pires de Souza
- Fellow Master degree, Postgraduate Program in Production Engineering, UFRN, Natal-RN, Brazil. Acquisition, interpretation and analysis of data; critical revision
| | - Amália Cinthia Meneses Rêgo
- PhD, Health Sciences, Natal-RN, Brazil. Design of the study, interpretation and analysis of data, manuscript writing, critical revision
| | - Irami Araújo-Filho
- Full Professor, Department of Surgery, UFRN and Universidade Potiguar (UnP), Natal-RN, Brazil. Design of the study, interpretation and analysis of data, manuscript writing, critical revision
| | - Aldo Cunha Medeiros
- PhD, Full Professor, Department of Surgery, UFRN, Natal-RN, Brazil. Design of the study, interpretation and analysis of data, manuscript writing, critical revision
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