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Khazaei A, Afshari A, Khatiban M, Borzou SR, Oshvandi K, Nabavian M, Maddineshat M. Perceptions of professional challenges by emergency medical services providers: a qualitative content analysis study. BMC Emerg Med 2024; 24:38. [PMID: 38448812 PMCID: PMC10916027 DOI: 10.1186/s12873-024-00955-6] [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: 08/12/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Emergency medical services (EMS) providers encounter a variety of challenges due to the unpredictable, uncontrollable, and dynamic conditions in the pre-hospital field. This study explored the perceived professional challenges among EMS providers. MATERIALS AND METHODS This study was conducted using a qualitative research approach and the method of content analysis. Eighteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. The collected data were then analyzed based on the Granheim and Lundman's method. RESULTS Based on data analysis, five categories and one theme were identified. The extracted theme was professional challenges. The five categories were as follows: Ineffective policies; multicultural and multidisciplinary factors; ambulance dispatch route problems; legal issues; and abuse against the emergency medical services CONCLUSION: In general, it has been found that EMS providers encounter numerous and complex professional challenges during their work. EMS managers can utilize the findings of the present study to develop strategies for reducing the professional challenges faced by EMS providers. By doing so, they can improve the quality of care in the prehospital field.
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Affiliation(s)
- Afshin Khazaei
- Department of Medical Emergencies, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Ali Afshari
- Chronic Diseases (Home Care) Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mahnaz Khatiban
- Mother and Child Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Reza Borzou
- Chronic Diseases (Home Care) Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majedeh Nabavian
- Department of Nursing and Midwifery, Comprehensive Health Research Center, Babol Branch, Islamic Azad University, Babol, Iran
| | - Maryam Maddineshat
- Department of Nursing, School of Malayer Nursing, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Heidet M, Benjamin Leung KH, Bougouin W, Alam R, Frattini B, Liang D, Jost D, Canon V, Deakin J, Hubert H, Christenson J, Vivien B, Chan T, Cariou A, Dumas F, Jouven X, Marijon E, Bennington S, Travers S, Souihi S, Mermet E, Freyssenge J, Arrouy L, Lecarpentier E, Derkenne C, Grunau B. Improving EMS response times for out-of-hospital cardiac arrest in urban areas using drone-like vertical take-off and landing air ambulances: An international, simulation-based cohort study. Resuscitation 2023; 193:109995. [PMID: 37813148 DOI: 10.1016/j.resuscitation.2023.109995] [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: 07/26/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Advances in vertical take-off and landing (VTOL) technologies may enable drone-like crewed air ambulances to rapidly respond to out-of-hospital cardiac arrest (OHCA) in urban areas. We estimated the impact of incorporating VTOL air ambulances on OHCA response intervals in two large urban centres in France and Canada. METHODS We included adult OHCAs occurring between Jan. 2017-Dec. 2018 within Greater Paris in France and Metro Vancouver in Canada. Both regions utilize tiered OHCA response with basic (BLS)- and advanced life support (ALS)-capable units. We simulated incorporating 1-2 ALS-capable VTOL air ambulances dedicated to OHCA response in each study region, and computed time intervals from call reception by emergency medical services (EMS) to arrival of the: (1) first ALS unit ("call-to-ALS arrival interval"); and (2) first EMS unit ("call-to-first EMS arrival interval"). RESULTS There were 6,217 OHCAs included during the study period (3,760 in Greater Paris and 2,457 in Metro Vancouver). Historical median call-to-ALS arrival intervals were 21 min [IQR 16-29] in Greater Paris and 12 min [IQR 9-17] in Metro Vancouver, while median call-to-first EMS arrival intervals were 11 min [IQR 8-14] and 7 min [IQR 5-8] respectively. Incorporating 1-2 VTOL air ambulances improved median call-to-ALS arrival intervals to 7-9 min and call-to-first EMS arrival intervals to 6-8 min in both study regions (all P < 0.001). CONCLUSION VTOL air ambulances dedicated to OHCA response may improve EMS response intervals, with substantial improvements in ALS response metrics.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France; Université Paris-Est Créteil (UPEC), CIR/TincNet (EA-3956), Créteil, France.
| | - K H Benjamin Leung
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | - Wulfran Bougouin
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Rejuana Alam
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | | | - Danny Liang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Daniel Jost
- Paris Fire Brigade (BSPP), Paris, France; Paris Sudden Death Expertise Center, Paris, France
| | | | | | | | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, Canada; Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Benoît Vivien
- AP-HP, SAMU 75, Necker University Hospital, Paris, France
| | - Timothy Chan
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | - Alain Cariou
- Paris Sudden Death Expertise Center, Paris, France; AP-HP, Medical Intensive Care Unit, Cochin University Hospital, Paris, France
| | - Florence Dumas
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Emergency Department, Cochin-Hotel-Dieu University Hospital, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Cardiology Department, European Georges Pompidou University Hospital, Paris, France
| | - Eloi Marijon
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Cardiology Department, European Georges Pompidou University Hospital, Paris, France
| | - Steven Bennington
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France
| | | | - Sami Souihi
- Université Paris-Est Créteil (UPEC), CIR/TincNet (EA-3956), Créteil, France
| | - Eric Mermet
- Centre National pour la Recherche scientifique (CNRS), TSE-R, UMR 5314, Toulouse, France; Toulouse School of Economics (TSE), Toulouse, France
| | - Julie Freyssenge
- Université Claude Bernard Lyon 1, INSERME U1290, Research on Healthcare Performance (RESHAPE), Lyon, France; Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France
| | - Laurence Arrouy
- AP-HP, Emergency Department, Paris Ile-de-France Ouest University Hospitals, Ambroise Paré University Hospital, Boulogne-Billancourt, France
| | - Eric Lecarpentier
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France
| | - Clément Derkenne
- Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Brian Grunau
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, Canada; Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada
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Strandqvist E, Olheden S, Bäckman A, Jörnvall H, Bäckström D. Physician-staffed prehospital units: a retrospective follow-up from an urban area in Scandinavia. Int J Emerg Med 2023; 16:43. [PMID: 37452288 PMCID: PMC10349430 DOI: 10.1186/s12245-023-00519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The aim of this study was to determine when and how rapid response vehicles (RRVs) make a difference in prehospital care by investigating the number and kinds of RRV assignment dispatches and the prehospital characteristics and interventions involved. METHODS This retrospective cohort study was based on data from a quality assurance system where all assignments are registered. RRV staff register every assignment directly at the site, using a smartphone, tablet, or computer. There is no mandatory information requirement or time limit for registration. The study includes data for all RRVs operating in Region Stockholm, three during daytime hours and one at night - from January 1, 2021 to December 31, 2021. RESULTS In 2021, RRVs in Stockholm were dispatched on 11,283 occasions, of which 3,571 (31.6%) resulted in stand-downs. In general, stand-downs were less common for older patients. The most common dispatch category was blunt trauma (1,584 or 14.0%), which accounted for the highest frequency of stand-downs (676 or 6.0%). The second most common category was cardiac arrest (1,086 or 9.6%), followed by shortness of breath (691 or 6.1%), medical not specified (N/S) (596 or 5.3%), and seizures (572 or 5.1%). CONCLUSION The study findings confirm that RRVs provide valuable assistance to the ambulance service in Stockholm, especially for cardiac arrest and trauma patients. In particular, RRV personnel have more advanced medical knowledge and can administer medications and perform interventions that the regular ambulance service cannot provide.
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Affiliation(s)
| | - Staffan Olheden
- Capio Akutläkarbilar, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Department of Perioperative Care, Solna Karolinska University Hospital, Stockholm, Sweden
| | - Anders Bäckman
- Capio Akutläkarbilar, Stockholm, Sweden
- Center for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Henrik Jörnvall
- Capio Akutläkarbilar, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Department of Perioperative Care, Solna Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Denise Bäckström
- Capio Akutläkarbilar, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
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4
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Watchorn A, Curran J, Heilman J, Balfour N, McCarroll K, Speers S, Harris D. Feasibility of patient-controlled analgesia (PCA) for rural and remote transfers. CAN J EMERG MED 2023; 25:157-163. [PMID: 36565428 DOI: 10.1007/s43678-022-00417-7] [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: 06/08/2022] [Accepted: 11/11/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND In rural Canada, the majority of prehospital care is provided by basic life support paramedics, who cannot administer opioids or parenteral analgesics. Patients requiring transfer to a higher level of care have limited options for pain control. We aim to determine if ambulance-based patient-controlled analgesia (PCA) is feasible during inter-facility transfers. METHODS This is a prospective non-consecutive cohort feasibility study conducted in the East Kootenay region of British Columbia from 2016 to 2020. Patients in acute pain from an illness or injury requiring an opioid and transfer to a higher level of care were offered PCA. The study used respiratory depression as a marker of safety, assessed if PCA during transport provided efficacious analgesia, measured satisfaction scores from patients and paramedics, and tracked adverse events. RESULTS 84 patients received PCA. The majority had orthopaedic trauma and the average transfer time was 3 h 22 min. The average pain score at the start and end of the transfer was unchanged, at 4 out of 10. Patient and paramedic satisfaction scores at the end of the transfer were 4.6 and 4.7 out of 5, respectively. Three out of the 84 patients (3.6%) had desaturation episodes below or equal to 90% oxygen saturation; however, all resolved with supplemental oxygen. INTERPRETATION Ambulance-based PCA is feasible and has a high level of satisfaction among paramedics and patients. It has significant potential for inter-facility transport in rural regions in Canada where ambulances are staffed with paramedics who cannot administer opioids or other parenteral analgesics.
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Affiliation(s)
- Adam Watchorn
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada.
- Interior Health Authority, Kelowna, BC, Canada.
| | | | - James Heilman
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Nick Balfour
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Kirk McCarroll
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Shauna Speers
- British Columbia Emergency Health Services, Saanichton, BC, Canada
| | - Devin Harris
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
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Heidet M, Freyssenge J, Claustre C, Deakin J, Helmer J, Thomas-Lamotte B, Wohl M, Danny Liang L, Hubert H, Baert V, Vilhelm C, Fraticelli L, Mermet É, Benhamed A, Revaux F, Lecarpentier É, Debaty G, Tazarourte K, Cheskes S, Christenson J, El Khoury C, Grunau B. Association between location of out-of-hospital cardiac arrest, on-scene socioeconomic status, and accessibility to public automated defibrillators in two large metropolitan areas in Canada and France. Resuscitation 2022; 181:97-109. [PMID: 36309249 DOI: 10.1016/j.resuscitation.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
AIM To compare walking access times to automated external defibrillators (AEDs) between area-level quintiles of socioeconomic status (SES) in out-of-hospital cardiac arrest (OHCA) cases occurring in 2 major urban regions of Canada and France. METHODS This was an international, multicenter, retrospective cohort study of adult, non-traumatic OHCA cases in the metropolitan Vancouver (Canada) and Rhône County (France) regions that occurred between 2014 and 2018. We calculated area-level SES for each case, using quintiles of country-specific scores (Q5 = most deprived). We identified AED locations from local registries. The primary outcome was the simulated walking time from the OHCA location to the closest AED (continuous and dichotomized by a 3-minute 1-way threshold). We fit multivariate models to analyze the association between OHCA-to-AED walking time and outcomes (Q5 vs others). RESULTS A total of 6,187 and 3,239 cases were included from the Metro Vancouver and Rhône County areas, respectively. In Metro Vancouver Q5 areas (vs Q1-Q4), areas, AEDs were farther from (79 % over 400 m from case vs 67 %, p < 0.001) and required longer walking times to (97 % above 3 min vs 91 %, p < 0.001) cases. In Rhône Q5 areas, AEDs were closer than in other areas (43 % over 400 m from case vs 50 %, p = 0.01), yet similarly poorly accessible (85 % above 3 min vs 86 %, p = 0.79). In multivariate models, AED access time ≥ 3 min was associated with decreased odds of survival at hospital discharge in Metro Vancouver (odds ratio 0.41, 95 % CI [0.23-0.74], p = 0.003). CONCLUSIONS Accessibility of public AEDs was globally poor in Metro Vancouver and Rhône, and even poorer in Metro Vancouver's socioeconomically deprived areas.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil (UPEC), EA-3956 (Control in Intelligent Networks [CIR]), Créteil, France.
| | - Julie Freyssenge
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), Lyon, France; Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France
| | | | - John Deakin
- British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Jennie Helmer
- British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Bruno Thomas-Lamotte
- Association pour le recensement et la localisation des défibrillateurs (ARLoD), Paris, France
| | - Mathys Wohl
- Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France
| | - Li Danny Liang
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Hervé Hubert
- Registre électronique des arrêts cardiaques (RéAC), Université de Lille, Lille, France; Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Valentine Baert
- Registre électronique des arrêts cardiaques (RéAC), Université de Lille, Lille, France; Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Christian Vilhelm
- Registre électronique des arrêts cardiaques (RéAC), Université de Lille, Lille, France
| | - Laurie Fraticelli
- Université Claude Bernard Lyon 1, Laboratoire Parcours Santé Systémique (P2S) UR 4129, Lyon, France
| | - Éric Mermet
- École des hautes études en sciences sociales (EHESS), Centre d'analyse et de mathématiques sociales (CAMS), Paris, France; Centre national de la recherche scientifique (CNRS), Institut des systèmes complexes (ISC-PIF), Paris, France
| | - Axel Benhamed
- Hospices civils de Lyon, SAMU 69 and Emergency Department, Lyon, France
| | - François Revaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux universitaires Henri Mondor, Créteil, France
| | - Éric Lecarpentier
- Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux universitaires Henri Mondor, Créteil, France
| | - Guillaume Debaty
- Université Grenoble Alpes, CNRS, TIMC, UMR 5525, Grenoble, France; Hôpital universitaire Grenoble Alpes, SAMU 38, Grenoble, France
| | - Karim Tazarourte
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), Lyon, France; Hospices civils de Lyon, SAMU 69 and Emergency Department, Lyon, France
| | - Sheldon Cheskes
- Sunnybrook Center for Prehospital Medicine, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Jim Christenson
- University of British Columbia, Department of Emergency Medicine, Vancouver, British Columbia, Canada; Saint Paul's Hospital, Emergency Department, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHEOS), RESURECT Group, Providence Research, Vancouver, British Columbia, Canada
| | - Carlos El Khoury
- Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France; Médipôle Hôpital Mutualiste, Emergency Department, Lyon-Villeurbanne, France
| | - Brian Grunau
- University of British Columbia, Department of Emergency Medicine, Vancouver, British Columbia, Canada; Saint Paul's Hospital, Emergency Department, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHEOS), RESURECT Group, Providence Research, Vancouver, British Columbia, Canada
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6
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Touron M, Javaudin F, Lebastard Q, Baert V, Heidet M, Hubert H, Leclere B, Lascarrou JB. Effect of sodium bicarbonate on functional outcome in patients with out-of-hospital cardiac arrest: a post-hoc analysis of a French and North-American dataset. Eur J Emerg Med 2022; 29:210-220. [PMID: 35297385 DOI: 10.1097/mej.0000000000000918] [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: 11/25/2022]
Abstract
BACKGROUND AND IMPORTANCE No large randomised controlled trial has assessed the potential benefits on neurologic outcomes of prehospital sodium bicarbonate administration in patients with nontraumatic out-of-hospital cardiac arrest (OHCA). OBJECTIVE To obtain information of assistance in designing a randomised controlled trial of bicarbonate therapy after OHCA in specific patient subgroups. DESIGN We conducted two, separate, simultaneous, retrospective studies of two distinct, unlinked datasets. SETTING AND PARTICIPANTS One dataset was a French nationwide population-based registry (RéAC Registry, French dataset) and the other was a randomised controlled trial comparing continuous to interrupted chest compressions in North America (ROC-CCC trial, North-American dataset). INTERVENTION We investigated whether prehospital bicarbonate administration was associated with better neurologic outcomes. OUTCOME MEASURES AND ANALYSES The main outcome measure was the functional outcome at hospital discharge. To adjust for potential confounders, we conducted a nested propensity-score-matched analysis with inverse probability-of-treatment weighting. MAIN RESULTS In the French dataset, of the 54 807 patients, 1234 (2.2%) received sodium bicarbonate and 450 were matched. After propensity-score matching, sodium bicarbonate was not associated with a higher likelihood of favourable functional outcomes on day 30 [adjusted odds ratio (aOR), 0.912; 95% confidence interval (95%CI), 0.501-1.655]. In the North-American dataset, of the 23 711 included patients, 4902 (20.6%) received sodium bicarbonate and 1238 were matched. After propensity-score matching, sodium bicarbonate was associated with a lower likelihood of favourable functional outcomes at hospital discharge (aOR, 0.45; 95% CI, 0.34-0.58). CONCLUSION In patients with OHCA, prehospital sodium bicarbonate administration was not associated with neurologic outcomes in a French dataset and was associated with worse neurologic outcomes in a North-American dataset. Given the considerable variability in sodium bicarbonate use by different prehospital care systems and the potential resuscitation-time bias in the present study, a large randomised clinical trial targeting specific patient subgroups may be needed to determine whether sodium bicarbonate has a role in the prehospital management of prolonged OHCA.
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Affiliation(s)
- Maxime Touron
- Medecine Intensive Reanimation, Nantes University Hospital
| | | | | | - Valentine Baert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, Évaluation des technologies de santé et des pratiques médicales, Lille
- French National Out-Of-Hospital Cardiac Arrest Registry, Registre électronique des Arrêts Cardiaques, Lille
| | - Mathieu Heidet
- Emergency Department, University Hospital Centre, Creteil
| | - Hervé Hubert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, Évaluation des technologies de santé et des pratiques médicales, Lille
- French National Out-Of-Hospital Cardiac Arrest Registry, Registre électronique des Arrêts Cardiaques, Lille
| | - Brice Leclere
- Public Health Department, University Hospital Centre, Nantes
| | - Jean-Baptiste Lascarrou
- Medecine Intensive Reanimation, Nantes University Hospital
- AfterROSC Network
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
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7
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Heidet M, Hubert H, Grunau BE, Cheskes S, Baert V, Fraticelli L, Freyssenge J, Lecarpentier E, Stitt A, Tallon JM, Tazarourte K, Truong C, Vaillancourt C, Vilhelm C, Wysocki K, Christenson J, El Khoury C. Rationale, development and implementation of the ReACanROC registry for out-of-hospital cardiac arrests in France and Canada. Emerg Med J 2021; 39:547-553. [PMID: 34083429 DOI: 10.1136/emermed-2020-211073] [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: 12/17/2020] [Accepted: 05/24/2021] [Indexed: 11/04/2022]
Abstract
France and Canada prehospital systems and care delivery in out-of-hospital cardiac arrests (OHCAs) show substantial differences. This article aims to describe the rationale, design, implementation and expected research implications of the international, population-based, France-Canada registry for OHCAs, namely ReACanROC, which is built from the merging of two nation-wide, population-based, Utstein-style prospectively implemented registries for OHCAs attended to by emergency medical services. Under the supervision of an international steering committee and research network, the ReACanROC dataset will be used to run in-depth analyses on the differences in organisational, practical and geographic predictors of survival after OHCA between France and Canada. ReACanROC is the first Europe-North America registry ever created to meet this goal. To date, it covers close to 80 million people over the two countries, and includes approximately 200 000 cases over a 10-year period.
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Affiliation(s)
- Matthieu Heidet
- SAMU 94, Hôpitaux universitaires Henri Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France .,EA-3956 (Intelligent Control in Networks, CIR), Université Paris-Est Créteil (UPEC), Créteil, France.,Emergency department, Hôpitaux universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Hervé Hubert
- ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France.,French national out-of-hospital cardiac arrest registry - Registre électronique des Arrêts Cardiaques (RéAC), Lille, France
| | - Brian E Grunau
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Emergency Department, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre for health evaluation and outcomes sciences (CHEOS), Vancouver, British Columbia, Canada.,British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Sheldon Cheskes
- Sunnybrook center for prehospital medicine, Toronto, Ontario, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Valentine Baert
- ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France.,French national out-of-hospital cardiac arrest registry - Registre électronique des Arrêts Cardiaques (RéAC), Lille, France
| | - Laurie Fraticelli
- RESCUE Network, Hussel Hospital, Vienne, France.,EA-4129 (Laboratory Systemic Health Care), University of Lyon 1, Lyon, France
| | - Julie Freyssenge
- RESCUE Network, Hussel Hospital, Vienne, France.,INSERM U1290 (Research on Healthcare Performance, RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Eric Lecarpentier
- SAMU 94, Hôpitaux universitaires Henri Mondor, Assistance Publique - Hopitaux de Paris (AP-HP), Créteil, France
| | - Audra Stitt
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - John M Tallon
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Emergency Health Services (BCEHS), Vancouver, British Columbia, Canada
| | - Karim Tazarourte
- INSERM U1290 (Research on Healthcare Performance, RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.,Emergency Department and SAMU69, Hospices Civils de Lyon, Lyon, France
| | - Courtney Truong
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christian Vilhelm
- French national out-of-hospital cardiac arrest registry - Registre électronique des Arrêts Cardiaques (RéAC), Lille, France
| | - Kosma Wysocki
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
| | - Jim Christenson
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Emergency Department, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre for health evaluation and outcomes sciences (CHEOS), Vancouver, British Columbia, Canada
| | - Carlos El Khoury
- RESCUE Network, Hussel Hospital, Vienne, France.,INSERM U1290 (Research on Healthcare Performance, RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.,Emergency Department, Médipôle, Villeurbanne, France
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Donnelly EA, Bradford P, Davis M, Hedges C, Socha D, Morassutti P, Pichika SC. What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes. J Am Coll Emerg Physicians Open 2020; 1:460-473. [PMID: 33000071 PMCID: PMC7493488 DOI: 10.1002/emp2.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes. METHODS A cross-sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post-traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non-responder survey was conducted to asses for demographic differences in those who did and did not complete the survey. RESULTS This survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes. CONCLUSION These findings illustrate that a host of different stressors may influence safety-related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.
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Affiliation(s)
| | - Paul Bradford
- Department of Emergency Medicine Windsor Regional Hospital Southwest Ontario Regional Base Hospital Program University of Western Ontario London Ontario Canada
| | - Matthew Davis
- Division of Emergency Medicine Southwest Ontario Regional Base Hospital Program University of Western Ontario London Ontario Canada
| | | | - Doug Socha
- Hastings-Quinte Paramedic Services Belleville Ontario Canada
| | - Peter Morassutti
- Southwest Ontario Regional Base Hospital Program-Windsor Site Windsor Ontario Canada
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Heidet M, Fraticelli L, Grunau B, Cheskes S, Baert V, Vilhelm C, Hubert H, Tazarourte K, Vaillancourt C, Tallon J, Christenson J, El Khoury C. ReACanROC: Towards the creation of a France–Canada research network for out-of-hospital cardiac arrest. Resuscitation 2020; 152:133-140. [DOI: 10.1016/j.resuscitation.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
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Geri G, Scales DC, Koh M, Wijeysundera HC, Lin S, Feldman M, Cheskes S, Dorian P, Isaranuwatchai W, Morrison LJ, Ko DT. Healthcare costs and resource utilization associated with treatment of out-of-hospital cardiac arrest. Resuscitation 2020; 153:234-242. [PMID: 32422247 DOI: 10.1016/j.resuscitation.2020.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The management of out-of-hospital cardiac arrest (OHCA) patients requires the coordination of prehospital, in-hospital and post-discharge teams. Data reporting a comprehensive analysis of all costs associated with treating OHCA are scarce. We aimed to describe the total costs (and their components) related to the management of OHCA patients. PATIENT AND METHODS We performed an analysis on a merged database of the Toronto Regional RescuNet Epistry database (prehospital data) and administrative population-based databases in Ontario. All non-traumatic OHCA patients over 18 years of age treated by the EMS between January 1, 2006, and March 31, 2014, were included in this study. The primary outcome was per patient longitudinal cumulative healthcare costs, from time of collapse to a maximum follow-up until death or 30 days after the event. We included all available cost sectors, from the perspective of the health system payer. We used multivariable generalized linear models with a logarithmic link and a gamma distribution to determine predictors of healthcare costs. RESULTS 25,826/44,637 patients were treated by EMS services for an OHCA (mostly male 64.4%, mean age 70.1). 11,727 (45%) were pronounced dead on scene, 8359 (32%) died in the emergency department, 3640 (14%) were admitted to hospital but died before day-30, and 2100 (8.1%) were still alive at day-30. Total cost was $690 [interquartile range (IQR) $308, $1742] per patient; ranging from $290 [IQR $188, $390] for patients who were pronounced on scene to $39,216 [IQR 21,802, 62,093] for patients who were still alive at day-30. In-hospital costs accounted for 93% of total costs. After adjustment for age and gender, rate of patient survival was the main driver of total costs: the rate ratio was 3.88 (95% confidence interval 3.80, 3.95), 49.46 and 148.89 for patients who died in the ED, patients who died after the ED but within 30 days, and patients who were still alive at day-30 compared to patients who were pronounced dead on scene, respectively. Factors independently associated with costs were the number of prehospital teams (rate ratio (RR) 5.50 [5.32, 5.67] for being treated by 4 teams vs. 1), the need for hospital transfer (RR 2.38 [2.01, 2.82]), coronary angiography (RR 1.43 [1.27, 1.62]) and targeted temperature management (RR 1.25 [1.09, 1.44]). CONCLUSION Survival is the main driver of total costs of treating OHCA patients in a large Canadian health system. Inpatient costs accounted for the majority of the total costs; potentially modifiable factors include the number of prehospital teams that arrive to the scene of the arrest and the need for between-hospital transfers after successful resuscitation.
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Affiliation(s)
- Guillaume Geri
- Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Damon C Scales
- ICES, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Harindra C Wijeysundera
- ICES, Toronto, Ontario, Canada; Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steve Lin
- Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Feldman
- Sunnybrook Centre for Prehospital Medicine, Sunnybrook health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sheldon Cheskes
- Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Dennis T Ko
- Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND Each year, about 500,000 people suffer a cardiac arrest (either out-of-hospital or in-hospital) in the USA. Although significant improvements in survival have occurred through the implementation of complex high-quality protocols of care, global costs related to such management are not clearly described. METHODS We will undertake a systematic review of the published literature on costs related to the acute phase of cardiac arrest management (from collapse to hospital discharge). The search will cover the period 1991 to present, and we will include studies written in English or in French involving patients with cardiac arrest of all ages, settings (in- and out-of-hospital arrest), countries, and etiology (including traumatic). The primary outcome will include estimates of costs related to cardiac arrest patients' management in various categories (e.g., resuscitation process, in-hospital management as well as rehabilitation and long-term care facilities) and perspectives (e.g., hospital, societal, or third-payer perspective). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and data quality will be assessed by questions adapted from the Drummond economic evaluation checklist. DISCUSSION This review will provide an estimate of costs related to cardiac arrest management according to the different components of such a management as well as total costs. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews PROSPERO CRD42016046993.
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12
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Navarro Moya P, González Carrasco M, Villar Hoz E. Psychosocial risk and protective factors for the health and well-being of professionals working in emergency and non-emergency medical transport services, identified via questionnaires. Scand J Trauma Resusc Emerg Med 2017; 25:88. [PMID: 28877702 PMCID: PMC5586025 DOI: 10.1186/s13049-017-0433-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An increase in the demand for MT services has, in turn, increased interest in the study of the psychosocial risk factors affecting the health of workers in this sector. However, research thus far has not distinguished between emergency (EMT) and non-emergency (non-EMT) services, nor between the sexes. Furthermore, little emphasis has been placed on the protective factors involved. The main objective of the present study is to identify any existing differential exposure – for reasons of work setting (EMT and non-EMT) or of gender – to the various psychosocial risk and protective factors affecting the health of MT workers. Methods Descriptive and transversal research with responses from 201 professionals. Results The scores obtained on the various psychosocial scales in our study – as indicators of future health problems – were more unfavourable for non-EMT workers than they were for EMT workers. Work setting, but not gender, was able to account for these differences. Discussion The scores obtained for the different psychosocial factors are generally more favourable for the professionals we surveyed than those obtained in previous samples. Conclusion The significant differences observed between EMT and non-EMT personnel raise important questions regarding the organization of work in companies that carry out both services at the same time in the same territory. The relationships among the set of risk/protective factors suggests a need for further investigation into working conditions as well as a consideration of the workers’ sense of coherence and subjective well-being as protective factors against occupational burnout syndrome.
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Affiliation(s)
- P Navarro Moya
- Doctoral student in Psychology, Health and Quality of Life, University of Girona, Girona, Spain.
| | - M González Carrasco
- Doctor of Psychology, Institut de Recerca sobre Qualitat de Vida, University of Girona, Girona, Spain
| | - E Villar Hoz
- Doctor of Psychology, Departament de Psicologia, University of Girona, Girona, Spain
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Doupe MB, Day S, Palatnick W, Chochinov A, Chateau D, Snider C, Lobato de Faria R, Weldon E, Derksen S. An ED paradox: patients who arrive by ambulance and then leave without consulting an ED provider. Emerg Med J 2016; 34:151-156. [PMID: 27707792 DOI: 10.1136/emermed-2015-205165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Scientists have called for strategies to identify ED patients with unmet needs. We identify the unique profile of ED patients who arrive by ambulance and subsequently leave without consulting a provider (ie, a paradoxical visit, PV). METHODS Using a retrospective cohort design, administrative data from Winnipeg, Manitoba were interrogated to identify all ED patients 17+ years old as having zero, single or multiple PVs in 2012/2013. Analyses compare the sociodemographic, physical (eg, arthritis), mental (eg, substance abuse) and concurrent healthcare use profile of non-PV, single and multiple PV patients. RESULTS The study cohort consisted of 122 639 patients with 250 754 ED visits. Across all ED sites, 2.3% of patients (N=2815) made 3387 PVs, comprising 1.4% of all ED visits. Descriptively, more single versus non-PV patients lived in urban core and lowest-income areas, were frequent ED users generally, were substance abusers and had seven plus primary care physician visits. Multiple PV patients had a similar but more extreme profile versus their single PV counterparts (eg, 54.7% of multiple vs 27.4% of single PV patients had substance abuse challenges). From multivariate statistics, single versus non-PV patients are defined uniquely by their frequent ED use, by their substance abuse, as living in a core and low income area, and as having multiple visits with primary care physicians. CONCLUSIONS PV patients have needs that do not align with the acute model of ED care. These patients may benefit from a more integrated care approach likely involving allied health professionals.
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Affiliation(s)
- Malcolm B Doupe
- Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne Day
- Women's Xchange, Women's College Hospital, Toronto, Ontario, Canada
| | - Wes Palatnick
- Faculty of Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alecs Chochinov
- Faculty of Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Faculty of Medicine, Department of Community Health Sciences, Manitoba Centre for Health Policy (MCHP), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolyn Snider
- Faculty of Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Erin Weldon
- Faculty of Medicine, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shelley Derksen
- Faculty of Medicine, Manitoba Centre for Health Policy (MCHP), University of Manitoba, Winnipeg, Manitoba, Canada
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Metelmann C, Metelmann B, Wendt M, Meissner K, von der Heyden M. LiveCity. INTERNATIONAL JOURNAL OF ELECTRONIC GOVERNMENT RESEARCH 2014. [DOI: 10.4018/ijegr.2014070104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The goal of emergency medicine is to treat time-critical diseases and conditions to reduce morbidity and mortality. The improvement of emergency medicine is an important topic for governments worldwide. A common problem is the inevitable lack of support by emergency doctors, when paramedics need their assistance at the emergency site but are without an emergency doctor. Video-communication in real time from the emergency site to an emergency doctor, offers an opportunity to enhance the quality of emergency medicine. The core piece of this study is a video camera system called “LiveCity camera”, enabling real-time high quality video connection of paramedics and emergency doctors. The impact of video communication on emergency medicine is clearly appreciated among providers, based upon the extent of agreement that has been stated in this study´s questionnaire by doctors and paramedics. This study is part of the FP7-European Union funded research project “LiveCity” (Grant Agreement No. 297291).
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Affiliation(s)
- Camilla Metelmann
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bibiana Metelmann
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Michael Wendt
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Konrad Meissner
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Martin von der Heyden
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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15
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KRÜGER AJ, LOSSIUS HM, MIKKELSEN S, KUROLA J, CASTRÉN M, SKOGVOLL E. Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia: a prospective population-based study. Acta Anaesthesiol Scand 2013; 57:1175-85. [PMID: 24001223 DOI: 10.1111/aas.12181] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence and severity. METHODS This population-based, prospective study recorded activity in 16 anaesthesiologist-staffed pre-hospital services in Denmark, Finland, Norway and Sweden serving half of the Scandinavian population. We calculated population incidence of medical conditions, and the proportion of patients with severely deranged vital signs and/or receiving advanced therapy. RESULTS Four thousand two hundred thirty-six alarm calls were recorded during 4 weeks. Two thousand two hundred fity-six alarms resulted in a patient encounter. The population incidence varied from 74.9 missions per 10,000 person-years (Denmark), followed by Finland with 14.6, Norway with 11, and Sweden with 5. Medical aetiology was most frequent (14.9 missions per 10,000 person-years, 95% CI: 14.2-15.8). Trauma was second (5.6 missions per 10,000 person-years, 95%CI: 5.12-6.09). Twenty-three per cent of patients had severely deranged vital functions, and advanced emergency medical procedures were performed in every four to twelve encounters (Denmark 8%, Sweden 15%, Norway 23%, and Finland 25%). The probability that the patient was physiologically deranged, received advanced medication, or procedure was 35%. Critical illness or injury occured at a rate of 25-30 per 10,000 person-years. CONCLUSIONS The incidence of pre-hospital anaesthesiologist patient encounters in Scandinavia varies. Medical aetiology is most frequent. Almost one-quarter of patients presents with deranged vital functions requiring emergency measures. The Scandinavian pre-hospital population incidence of critical illness and injury is 25-30 per 10,000 person-years.
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Affiliation(s)
| | | | - S. MIKKELSEN
- Mobile Emergency Care Unit; Department of Anaesthesiology and Intensive Care Medicine; Odense University Hospital; Odense; Denmark
| | - J. KUROLA
- Centre for Prehospital Emergency Care; Kuopio University Hospital; Kuopio; Finland
| | - M. CASTRÉN
- Karolinska Institutet; Department of Clinical Science and Education; Södersjukhuset and Section of Emergency Medicine; Stockholm; Sweden
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Bahadori M, Ravangard R. Determining and Prioritizing the Organizational Determinants of Emergency Medical Services (EMS) in Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:307-11. [PMID: 24083003 PMCID: PMC3785904 DOI: 10.5812/ircmj.2192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/01/2011] [Indexed: 11/29/2022]
Abstract
Background Improving the organization of pre-hospital emergency to provide emergency medical services (EMS), as a part of health system, plays an important role in timely and properly response to incidents, as well as, reducing mortalities and disabilities. Objective This study was conducted to determine the organizational determinants of emergency medical services in Iran and analyze their relationship and prioritize them. Materials and Methods The present study is kind of descriptive and cross-sectional study that has been conducted on the first half of 2010 using DEMATEL method (a group decision-making technique). Required data were collected using a questionnaire from a sample of 30 Iranian experts in pre-hospital emergency, who were selected using available sampling method. Results The determinants of establishing an independent EMS organization as a policy maker and observer organization, providing services through public organizations such as Emergency 115, private organizations partnership in pre-hospital emergency system, and integrating pre-hospital and hospital emergency under single supervision and management were determined as organizational determinants. Also, establishing an independent EMS organization and integrating pre-hospital and hospital emergency under single supervision and management were determined as the most affecting and affected organizational determinants, respectively, with the coordinates (1.01 and 1.01) and (0.85 and - 0.85) in the pre-hospital emergency organizational determinants graph. Conclusions Emergency medical services should be considered as a system with its independent components. Establishing an independent EMS organization, integrating pre-hospital and hospital emergency under single supervision and management, as well as, extending the possibility of providing EMS through private sector are essential in order to make fundamental reforms in providing emergency medical services in Iran.
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Affiliation(s)
- Mohammadkarim Bahadori
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammadkarim Bahadori, Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tell: +98-2182482416, Fax: +98-2188057022, E-mail:
| | - Ramin Ravangard
- School of Management and Medical Information Sciences, Shiraz University of Medical Sciences (SUMS), Shiraz, IR Iran
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Al-Shaqsi S. Models of International Emergency Medical Service (EMS) Systems. Oman Med J 2011; 25:320-3. [PMID: 22043368 DOI: 10.5001/omj.2010.92] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/27/2010] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sultan Al-Shaqsi
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Prehospital ultrasound as the evolution of the Franco-German model of prehospital EMS. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0077-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractPurposeTo evaluate, throughout model analysis and evaluation of existing literature and personal experience, which can be the benefits of routine performance of prehospital ultrasound in the different models of prehospital emergency medical service.MethodsThe existing literature was reviewed.ConclusionsThe ultrasound can be a very valuable asset in both the Anglo-American and the Franco-German models. In the latter, however, its role is further emphasized since US-enhanced on-spot early diagnosis performed by the physician can be beneficial to the whole system and not just the single patient.
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Lockey D. International EMS systems: Geographical lottery and diversity but many common challenges. Resuscitation 2009; 80:722. [PMID: 19427091 DOI: 10.1016/j.resuscitation.2009.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/29/2009] [Indexed: 10/20/2022]
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Davis DP, Garberson LA, Andrusiek DL, Hostler D, Daya M, Pirrallo R, Craig A, Stephens S, Larsen J, Drum AF, Fowler R. A descriptive analysis of Emergency Medical Service Systems participating in the Resuscitation Outcomes Consortium (ROC) network. PREHOSP EMERG CARE 2008; 11:369-82. [PMID: 17907019 DOI: 10.1080/10903120701537147] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The optimal Emergency Medical Services (EMS) system characteristics have not been defined, resulting in substantial variability across systems. The Resuscitation Outcomes Consortium (ROC) is a United States-Canada research network that organized EMS agencies from 11 different systems to perform controlled trials in cardiac arrest and life-threatening trauma resuscitation. OBJECTIVES To describe EMS systems participating in ROC using a novel framework. METHODS Standardized surveys were created by ROC investigators and distributed to each site for completion. These included separate questions for individual hospitals, EMS agencies, and dispatch centers. Results were collated and analyzed by using descriptive statistics. RESULTS A total of 264 EMS agencies, 287 hospitals, and 154 dispatch centers were included. Agencies were described with respect to the type (fire-based, non-fire governmental, private), transport status (transport/non-transport), and training level (BLS/ALS). Hospitals were described with regard to their trauma designation and the presence of electrophysiology and cardiac catheterization laboratories. Dispatch center characteristics, including primary versus secondary public safety answering point (PSAP) status and the use of prearrival instructions, were also described. Differences in EMS system characteristics between ROC sites were observed with multiple intriguing patterns. Rural areas and fire-based agencies had more EMS units and providers per capita. This may reflect longer response and transport distances in rural areas and the additional duties of most fire-based providers. In addition, hospitals in the United States typically had catheterization laboratories, whereas Canadian hospitals generally did not. The vast majority of both primary and secondary PSAPs use computer-aided dispatch. CONCLUSIONS Similarities and differences among EMS systems participating in the ROC network were described. The framework used in this analysis may serve as a template for future EMS research.
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Affiliation(s)
- Daniel P Davis
- Department of Emergency Medicine, The University of California San Diego, San Diego, CA, USA
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