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Cernuda Martínez JA, Castro Delgado R, Arcos González P. Difficulties of Spanish Primary Health Care nurses to assist emergencies: A cross-sectional study. Int Emerg Nurs 2024; 74:101442. [PMID: 38537317 DOI: 10.1016/j.ienj.2024.101442] [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: 09/09/2022] [Revised: 03/02/2024] [Accepted: 03/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The competence of a Primary Health Care nurse to handle emergency situations depends largely on prior acquisition of theoretical knowledge to make appropriate decisions, combined with the corresponding practical skills to carry out swift and effective interventions. METHODS Cross-sectional study conducted in through a survey auto-administered to a simple random sample of 269 nurses (n) with replacement of Asturias, Spain from the total nursing staff of 730 members (N) in Asturias. RESULTS In rural areas, the most frequently mentioned reasons were the lack of practical skills (18.9%) and the absence of adequate material (14.4 %). In the semi-urban area, the most common reasons were the lack of practical skills (13.2 %) and the lack of theoretical knowledge (10.3 %). Finally, in the urban area, the main reasons were the lack of practical skills (14.4 %) and the absence of adequate material (7.2 %). The differences were significant (p = 0.025). CONCLUSIONS Despite the requirement that they acquire the necessary theoretical and practical skills, not all PHC nurses perceive themselves to be sufficiently prepared. The degree of self-perceived acquisition of this knowledge and skills, which is so important and necessary, is heterogeneous, with clear differences according to the respective field of work.
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Affiliation(s)
| | - Rafael Castro Delgado
- Unit for Research in Emergency and Disaster. Faculty of Medicine and Health Sciences. University of Oviedo, Spain.
| | - Pedro Arcos González
- Unit for Research in Emergency and Disaster. Faculty of Medicine and Health Sciences. University of Oviedo, Spain.
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2
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Wend CM, Fransman RB, Haut ER. Prehospital Trauma Care. Surg Clin North Am 2024; 104:267-277. [PMID: 38453301 DOI: 10.1016/j.suc.2023.10.005] [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] [Indexed: 03/09/2024]
Abstract
Prehospital trauma evaluation begins with the primary assessment of airway, breathing, circulation, disability, and exposure. This is closely followed by vital signs and a secondary assessment. Key prehospital interventions include management and resuscitation according to the aforementioned principles with a focus on major hemorrhage control, airway compromise, and invasive management of tension pneumothorax. Determining the appropriate time and method for transportation (eg, ground ambulance, helicopter, police, private vehicle) to the hospital or when to terminate resuscitation are also important decisions to be made by emergency medical services clinicians.
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Affiliation(s)
- Christopher M Wend
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street Suite 6-100, Baltimore, MD 21287, USA
| | - Ryan B Fransman
- Department of Trauma, Acute Care Surgery, and Surgical Critical Care, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive, SE, Atlanta, GA 30303, USA
| | - Elliott R Haut
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street Suite 6-100, Baltimore, MD 21287, USA; Department of Surgery, Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed 6107C, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Jiao Z, Wang H, Fei C, Wang L, Yuan J, Meng Q, Lu X. A reconfigurable multi-terrain adaptive casualty transport aid base on Watt II six-bar linkage for industrial environment. Front Bioeng Biotechnol 2024; 12:1360902. [PMID: 38605994 PMCID: PMC11007234 DOI: 10.3389/fbioe.2024.1360902] [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: 12/24/2023] [Accepted: 03/08/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction: This paper presents the Reconfigurable Multi-Terrain Adaptive Casualty Transport Aid (RMTACTA), an innovative solution addressing the critical need for rapid and safe pre-hospital casualty transport in industrial environments. The RMTACTA, leveraging the Watt II six-bar linkage, offers enhanced adaptability through six modes of motion, overcoming the limitations of traditional stretchers and stretcher vehicles by facilitating navigation across narrow and challenging terrains. Methods: The RMTACTA's design incorporates two branching four-bar mechanisms to form a compact, reconfigurable Watt II six-bar linkage mechanism. This setup is controlled via a single remote rope, allowing for easy transition between its multiple operational modes, including stretcher, stretcher vehicle, folding, gangway-passing, obstacle-crossing, and upright modes. The mechanical design and kinematics of this innovative linkage are detailed, alongside an analysis of the optimal design and mechanical evaluation of rope control. Results: A prototype of the RMTACTA was developed, embodying the proposed mechanical and kinematic solutions. Preliminary tests were conducted to verify the prototype's feasibility and operability across different terrains, demonstrating its capability to safely and efficiently transport casualties. Discussion: The development of the proposed Reconfigurable Multi-Terrain Adaptive Casualty Transport Aid (RMTACTA) introduces a novel perspective on the design of emergency medical transport robots and the enhancement of casualty evacuation strategies. Its innovative application of the Watt II six-bar linkage mechanism not only showcases the RMTACTA's versatility across varied terrains but also illuminates its potential utility in critical scenarios such as earthquake relief, maritime rescue, and battlefield medical support.
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Affiliation(s)
- Zongqi Jiao
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Department of Orthopaedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Haibin Wang
- Department of Orthopaedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Cuizhi Fei
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Department of Orthopaedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Liang Wang
- Department of Orthopaedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jincan Yuan
- Department of Orthopaedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Qiaoling Meng
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Xuhua Lu
- Department of Orthopaedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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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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Thompson M, Jefferson O, James T, Waller B, Reed R, Slade H, Swift K, Pynn HJ. Defining capabilities in deployed UK military prehospital emergency care. BMJ Mil Health 2024; 170:150-154. [PMID: 38508774 DOI: 10.1136/military-2022-002159] [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: 05/16/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
The UK military prehospital emergency care (PHEC) operational clinical capability framework must be updated in order that it retains its use as a valid operational planning tool. Specific requirements include accurately defining the PHEC levels and the 'Medical Emergency Response Team' (MERT), while reinforcing PHEC as a specialist area of clinical practice that requires an assured set of competencies at all levels and mandatory clinical currency for vocational providers.A military PHEC review panel was convened by the Defence Consultant Advisor (DCA) for PHEC. Each PHEC level was reviewed and all issues which had, or could have arisen from the existing framework were discussed until agreement between the six members of this panel was established.An updated military PHEC framework has been produced by DCA PHEC, which defines the minimum requirements for each operational PHEC level. These definitions cover all PHEC providers, irrespective of professional background. The mandatory requirement for appropriate clinical exposure for vocational and specialist providers is emphasised. An updated definition of MERT has been agreed.This update provides clarity to the continually evolving domain of UK military PHEC. It sets out the PHEC provider requirements in order to be considered operationally deployable in a PHEC role. There are implications for training, manning and recruitment to meet these requirements, but the processes required to address these are already underway and well described elsewhere.
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Affiliation(s)
- Michael Thompson
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - O Jefferson
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T James
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - B Waller
- Navy Command Headquarters, Navy Healthcare, Portsmouth, UK
- Shackleton Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Reed
- Joint Hospital Group South West, Defence Medical Services, Plymouth, UK
- Anaesthetic Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - H Slade
- Royal Air Force Medical Services, RAF High Wycombe, UK
- Emergency Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - K Swift
- Tactical Medical Wing, Royal Air Force Medical Services, RAF Brize Norton, UK
| | - H J Pynn
- Department of Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Eichinger M, Reiterer S, Rief M, Eichlseder M, Pichler A, Zoidl P, Prause G. Use of bitemporal NACA score documentation in prehospital emergency medical services- a retrospective study. Int J Emerg Med 2024; 17:36. [PMID: 38454355 PMCID: PMC10918989 DOI: 10.1186/s12245-024-00605-5] [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: 11/04/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The assessment of illness severity in the prehospital setting is essential for guiding appropriate medical interventions. The National Advisory Committee for Aeronautics (NACA) score is a validated tool commonly used for this purpose. However, the potential benefits of using bitemporal documentation of NACA scores to capture the dynamic changes in emergency situations remain uncertain. The objective of this study was to evaluate the potential benefit of bitemporal NACA score documentation in the prehospital setting, specifically in assessing the dynamic changes of emergencies and facilitating quality improvement through enhanced documentation practices. METHODS In this retrospective study, data from prehospital emergency patients were analyzed who received care from the physician response unit between January 1, 2018, and May 31, 2021. Patient demographics, NACA scores, indications for emergency care, and changes in NACA scores were extracted from medical records. Statistical analyses were performed to examine the associations between NACA scores, emergency categories, indications, and changes in NACA scores. RESULTS The study included 4005 patients, predominantly categorized as NACA III (33.7% at initial assessment, 41.8% at subsequent assessment) and NACA IV (31.6% at initial assessment, 22.4% at subsequent assessment). There was a significant improvement in NACA scores during the provision of prehospital care (p < 0.01). Notably, prehospital emergencies attributed to internal medical, neurological, traumatic, and paediatric causes demonstrated significant improvements in NACA scores (p < 0.01). Gender-specific differences were also observed. CONCLUSION Our study suggests that the bitemporal documentation of NACA scores can be advantageous in the prehospital setting and may have implications for research, practice, and policy.
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Affiliation(s)
- Michael Eichinger
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Sandro Reiterer
- Division of Anaesthesiology and Intensive Care Medicine 2, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Martin Rief
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria.
| | - Michael Eichlseder
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Alexander Pichler
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Philipp Zoidl
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Gerhard Prause
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
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Bourke-Matas E, Bosley E, Smith K, Meadley B, Bowles KA. Developing a consensus-based definition of out-of-hospital clinical deterioration: A Delphi study. Aust Crit Care 2024; 37:318-325. [PMID: 37537124 DOI: 10.1016/j.aucc.2023.05.008] [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: 10/03/2022] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Clinical deterioration is a time-critical medical emergency requiring rapid recognition and intervention. Deteriorating patients are seen across various healthcare settings, including the out-of-hospital (OOH) environment. OOH care is an evolving area of medicine where decisions are made regarding priority and timing of clinical interventions, ongoing management, and transport to appropriate care. To date, the literature lacks a standardised definition of OOH clinical deterioration. OBJECTIVE The objective of this study was to create a consensus-based definition of OOH clinical deterioration informed by emergency medicine health professionals. METHODS A Delphi study consisting three rounds was conducted electronically between June 2020 and January 2021. The expert panel consisted of 30 clinicians, including emergency physicians and paramedics. RESULTS A consensus-based definition of OOH clinical deterioration was identified as changes from a patient's baseline physiological status resulting in their condition worsening. These changes primarily take the form of measurable vital signs and assessable symptoms but should be evaluated in conjunction with the history of events and pertinent risk factors. Clinicians should be suspicious that a patient could deteriorate when changes occur in one or more of the following vital signs: respiratory rate, heart rate, blood pressure, Glasgow Coma Scale, oxygen saturation, electrocardiogram, and skin colour. Almost all participants (92%) indicated an early warning system would be helpful to assist timely recognition of deteriorating patients. CONCLUSION The creation of a consensus-based definition of OOH clinical deterioration can serve as a starting point for the development and validation of OOH-specific early warning systems. Moreover, a standardised definition allows meaningful comparisons to be made across health services and ensures consistency in future research. This study has shown recognition of OOH clinical deterioration to be a complex issue requiring further research. Improving our understanding of key factors contributing to deterioration can assist timely recognition and intervention, potentially reducing unnecessary morbidity and mortality.
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Affiliation(s)
- Emma Bourke-Matas
- Department of Paramedicine, School of Primary and Allied Health Care, Monash University, McMahons Rd, Frankston, Victoria, 3199, Australia; Queensland Ambulance Service, Department of Health, Emergency Services Complex, Cnr Park and Kedron Park Rds, Kedron, Queensland, 4031, Australia.
| | - Emma Bosley
- Queensland Ambulance Service, Department of Health, Emergency Services Complex, Cnr Park and Kedron Park Rds, Kedron, Queensland, 4031, Australia
| | - Karen Smith
- Department of Paramedicine, School of Primary and Allied Health Care, Monash University, McMahons Rd, Frankston, Victoria, 3199, Australia; Ambulance Victoria Centre for Research and Evaluation, 31 Joseph Street, Blackburn North, Victoria, 3130, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, 3181, Australia
| | - Ben Meadley
- Department of Paramedicine, School of Primary and Allied Health Care, Monash University, McMahons Rd, Frankston, Victoria, 3199, Australia; Ambulance Victoria Centre for Research and Evaluation, 31 Joseph Street, Blackburn North, Victoria, 3130, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, School of Primary and Allied Health Care, Monash University, McMahons Rd, Frankston, Victoria, 3199, Australia
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Rajeh Saifan A, Al-Jaafreh A, Mosleh SM, Mohammad Alsaraireh M, Al-Yateem N, Refaat Ahmed F, Arsyad Subu M. The lived experiences of healthcare professionals working in pre-hospital emergency services in Jordan: A qualitative exploratory study. Int Emerg Nurs 2024; 73:101405. [PMID: 38266322 DOI: 10.1016/j.ienj.2023.101405] [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: 12/22/2022] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Globally, injuries account for 9% of all deaths, with road accidents contributing to approximately a quarter of these fatalities. A major concern is the inadequacy of pre-hospital care (emergency medical services provided before arrival at a hospital) and delays in transportation to medical facilities, identified as leading causes of preventable injury-related deaths. This study explores the experiences of emergency health professionals (EHPs) in peri-hospital services (emergency medical services provided immediately upon arrival and within the hospital setting). METHODS A qualitative exploratory design, underpinned by Van Manen's (1990) descriptive phenomenological principles, was used. Thirty EHPs from five central and southern Jordanian emergency departments were purposefully sampled, including physicians, nurses, and paramedics from both emergency departments and pre-hospital services. RESULTS Two primary themes emerged: (1) In Search of Clarity: The Unsettled Journey of Pre-hospital Emergency Care Providers; (2) Frustrations on the Frontline: Role Ambiguity and Emotional Exhaustion in Trauma Care, with EHPs reporting fluid and unclear roles, physical and verbal abuse, and limited authority in critical interventions. CONCLUSION The study highlights several service lapses in peri-hospital care that negatively impact healthcare professionals, posing risks to patient safety. These findings urge decision-makers to devise actionable strategies to rectify these deficiencies, enhancing care quality and thereby decreasing injury-induced mortality and morbidity.
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Affiliation(s)
- Ahmad Rajeh Saifan
- Associate Professor of Nursing, Nursing Department, Applied Science Private University, Amman, Jordan.
| | - Ali Al-Jaafreh
- Paramedics Trainer, Civil Defense College, Amman, Jordan
| | - Sultan M Mosleh
- Faculty of Health Sciences, Higher Colleges of Technology, Fujairah PO Box 1626, United Arab Emirates; Faculty of Nursing, Mutah University, Karak, Jordan.
| | - Mahmoud Mohammad Alsaraireh
- Princess Aisha Bint Al Hussein College for Nursing and Health Sciences, Al Hussaein Bin Talal University, Maan, Jordan.
| | - Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates; Adjunct Associate Professor, Charles Sturt University, Australia.
| | - Fatma Refaat Ahmed
- Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates; Criticl Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt.
| | - Muhammad Arsyad Subu
- Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates; Faculty of Nursing and Midwifery, Universitas Binawan, Jakarta, Indonesia.
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Scott J, Thomas L, Joy T, McCrossan P. How can quality be measured within a physician-led Community Emergency Medical service? A scoping review protocol. Syst Rev 2024; 13:3. [PMID: 38167079 PMCID: PMC10759743 DOI: 10.1186/s13643-023-02424-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Quality measurement as part of quality improvement in healthcare is integral for service delivery and development. This is particularly pertinent for health services that deliver care in ways that differ from traditional practice. Community Emergency Medicine (CEM) is a novel and evolving concept of care delivered by services in parts of the UK and Ireland. This scoping review aims to provide a broad overview of how quality may be measured within services delivering CEM. METHODS AND ANALYSIS The methodology follows both the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). It is guided by recognised work of Arksey and O'Malley and the guidelines developed by the Joanna Briggs Institute. Several databases will be searched: MEDLINE, EMbase, EMcare, CINAHL, Scopus, the Cochrane Library and grey literature. Search terms have been developed by representatives within Community Emergency Medicine services. Two reviewers will independently screen eligible studies for final study selection. Results will be collected and analysed in descriptive and tabular form to illustrate the breadth of quality indicators that may be applicable to CEM services. This scoping review protocol has been registered with the Open Science Framework platform (osf.io/e7qxg). DISCUSSION This is the first stage of a larger research study aimed at developing national quality indicators for CEM. The purpose of this scoping review is to provide a comprehensive review of quality indicators that could be used within CEM. The results will be mapped using a framework and identify gaps in the literature to help guide future-focused research.
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Affiliation(s)
- Jamie Scott
- Physician Response Unit, Barts Health NHS Trust, London, UK.
| | - Libby Thomas
- Kings College Hospital NHS Foundation Trust, London, England
| | - Tony Joy
- Physician Response Unit, Barts Health NHS Trust, London, UK
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Betend R, Suppan L, Chan M, Regard S, Sarasin F, Fehlmann CA. Association between prehospital physician clinical experience and discharge at scene - retrospective cohort study. Swiss Med Wkly 2023; 153:3533. [PMID: 38579323 DOI: 10.57187/s.3533] [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: 04/07/2024] Open
Abstract
BACKGROUND Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied. OBJECTIVES To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience. DESIGN, SETTINGS AND PARTICIPANTS A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit ("service mobile d'urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties. EXPOSURE The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation. OUTCOME MEASURES AND ANALYSIS The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians. RESULTS In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4-6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13-1.21) and less supervision (aOR: 0.85, 95% CI: 0.82-0.88). CONCLUSION In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision.
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Affiliation(s)
- Romain Betend
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Michele Chan
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Simon Regard
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
- Division of Cantonal Physician, General Directorate of Health, Department of Security, Population and Health, Geneva, Switzerland
| | - François Sarasin
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Christophe A Fehlmann
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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11
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Sepahvand MJ, Nourozi K, Khankeh H, Mohammadi-Shahboulaghi F, Fallahi-Khoshknab M. Fears and Concerns of Bystanders to Help People Injured in Traffic Accidents: A Qualitative Descriptive Study. Emerg Med Int 2023; 2023:1862802. [PMID: 38099234 PMCID: PMC10721345 DOI: 10.1155/2023/1862802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
In most traffic accidents, bystanders arrive at the scene before the rescuers. If they provide the right help, they can play an important and effective role in reducing the number of deaths and complications caused by these accidents. However, in many cases, fears and concerns prevent bystanders from providing assistance. This study aims to investigate and understand the fears and concerns of bystanders when they decide to help in traffic accidents. In 2022, this study was carried out in Iran using a qualitative content analysis approach. The data was collected through semistructured interviews. Participants were 15 males and females who had experience providing assistance in traffic accidents. Interviews, after digital recording, were transcribed verbatim. A purposeful and theoretical sampling method was performed. Data analysis and the determination of codes, categories, and subcategories were done using qualitative analysis software. O'Brien's qualitative research reporting standard was used. The results of the study include a category of fears and concerns and five subcategories. The subcategories include fear and concern caused by lack of information, fear of legal troubles, stress caused by previous experience, fear and anxiety caused by anticipation, and anxiety of unknown origin. The results of this study showed that some of the fears and concerns of the bystanders were related to a lack of information about providing assistance. By increasing bystanders' information about assistance, such as first aid training, fear and anxiety caused by a lack of information can be reduced. Another part of the fear and concern of bystanders is due to legal issues. Passing and implementing laws that protect bystanders can help reduce this fear and concern. Bystanders should be trained to provide assistance according to the rules of assistance so that they do not get into legal problems. A part of the bystander's fear and concern stems from their previous experiences providing assistance in traffic accidents. These experiences can also affect the fear and anxiety caused by anticipation. It is necessary to conduct more studies on the role of bystanders' experiences in creating fear and anxiety in them, as well as their effect on anticipatory fear.
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Affiliation(s)
| | - Kian Nourozi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Khankeh
- Emergency and Disaster Health, University of Social Welfare and Rehabilitation Sciences, Associated at Department of Clinical Science and Education, Karolinska Institute, Tehran, Iran
| | - Farahnaz Mohammadi-Shahboulaghi
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoud Fallahi-Khoshknab
- Department of Nursing, Iranian Scientific Association of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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12
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Colalillo JM, Ley Greaves R. Medical volunteerism. Emerg Med Australas 2023; 35:1026-1027. [PMID: 37884275 DOI: 10.1111/1742-6723.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Affiliation(s)
- James M Colalillo
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Robbie Ley Greaves
- High Acuity Response Unit, Queensland Ambulance Service, Brisbane, Queensland, Australia
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13
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Hossain I, Rostami E, Marklund N. The management of severe traumatic brain injury in the initial postinjury hours - current evidence and controversies. Curr Opin Crit Care 2023; 29:650-658. [PMID: 37851061 PMCID: PMC10624411 DOI: 10.1097/mcc.0000000000001094] [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] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours. RECENT FINDINGS Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials. SUMMARY Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction.
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Affiliation(s)
- Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Elham Rostami
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala
- Department of Neuroscience, Karolinska institute, Stockholm
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
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14
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Nordquist H, Pappinen J, Torkki P, Nurmi J. Consultation Processes With Helicopter Emergency Medical Service Physicians in Finnish Prehospital Emergency Care: The Paramedics' Perspective. Air Med J 2023; 42:461-467. [PMID: 37996183 DOI: 10.1016/j.amj.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The Finnish emergency medical services operates mainly with highly educated paramedic-staffed units. Helicopter emergency medical services (HEMS) physicians alongside other physicians provide consultations to paramedics on the scene without the physician physically participating in the mission. We examined the Finnish paramedics' views regarding the consultation processes involving HEMS physicians. METHODS This was a cross-sectional survey study among paramedics (n = 200). Assessments of the performance of HEMS physicians and other physicians in the consultation process were analyzed descriptively. The effect of the physician being expressly part of the HEMS was analyzed with inductive content analysis. RESULTS Overall, consultations with the HEMS physician were well received among paramedics, and the HEMS physicians received higher assessments than other physicians. The familiarity with the prehospital environment, limitations, and local possibilities was valued. Expertise is particularly valuable in challenging emergency medical services missions but unnecessary in many nonurgent missions. There is scope for improvement in the attitudes and technical fluency of the consultation processes of HEMS physicians. CONCLUSION Using HEMS physicians in prehospital consultations could be recommended. Further studies are still needed to ensure the efficacy and efficiency of the consultation process and explore the integration of video connections into current consultation practices.
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Affiliation(s)
- Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland.
| | - Jukka Pappinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Stassen W, Wylie C, Craig W, Ebrahim I, Mahoney SH, Pusateri AE, Rambharose S, van Koningsbruggen C, Weiskopf RB, Wallis LA. The Effect of Prehospital Clinical Trial-Related Procedures on Scene Interval, Cognitive Load, and Error: A Randomized Simulation Study. PREHOSP EMERG CARE 2023:1-7. [PMID: 37713658 DOI: 10.1080/10903127.2023.2259998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Globally, very few settings have undertaken prehospital randomized controlled trials. Given this lack of experience, there is a risk that such trials in these settings may result in protocol deviations, increased prehospital intervals, and increased cognitive load, leading to error. Ultimately, this may affect patient safety and mortality. The aim of this study was to assess the effect of trial-related procedures on simulated scene interval, self-reported cognitive load, medical errors, and time to action. METHODS This was a prospective simulation study. Using a cross-over design, ten teams of prehospital clinicians were allocated to three separate simulation arms in a random order. Simulations were: (1) Eligibility assessment and administration of freeze-dried plasma (FDP) and a hemoglobin-based oxygen carrier (HBOC), (2) Eligibility assessment and administration of HBOC, (3) Eligibility assessment and standard care. All simulations also required clinical management of hemorrhagic shock. Simulated scene interval, error rates, cognitive load (measured by NASA Task Load Index), and competency in clinical care (assessed using the Simulation Assessment Tool Limiting Assessment Bias (SATLAB)) were measured. Mean differences between simulations with and without trial-related procedures were sought using one-way ANOVA or Kruskal-Wallis test. A p-value of <0.05 within the 95% confidence interval was considered significant. RESULTS Thirty simulations were undertaken, representing our powered sample size. The mean scene intervals were 00:16:56 for Simulation 1 (FDP and HBOC), 00:17:22 for Simulation 2 (HBOC only), and 00:14:24 for Simulation 3 (standard care). Scene interval did not differ between the groups (p = 0.27). There were also no significant differences in error rates (p = 0.28) or cognitive load (p = 0.67) between the simulation groups. There was no correlation between cognitive load and error rates (r = 0.15, p = 0.42). Competency was achieved in all the assessment criteria for all simulation groups. CONCLUSION In a simulated environment, eligibility screening, performance of trial-related procedures, and clinical management of patients with hemorrhagic shock can be completed competently by prehospital advanced life support clinicians without delaying transport or emergency care. Future prehospital clinical trials may use a similar approach to help ensure graded and cautious implementation of clinical trial procedures into prehospital emergency care systems.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Craig Wylie
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Wesley Craig
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Ismaeel Ebrahim
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Scott H Mahoney
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Anthony E Pusateri
- Naval Medical Research Unit-San Antonio, Fort Sam Houston, San Antonio, Texas, USA
| | - Sanjeev Rambharose
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
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Abebe A, Kebede Z, Demissie DB. Practice of Pre-Hospital Emergency Care and Associated Factors in Addis Ababa, Ethiopia: Facility-Based Cross-Sectional Study Design. Open Access Emerg Med 2023; 15:277-287. [PMID: 37701880 PMCID: PMC10493197 DOI: 10.2147/oaem.s424814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Background Medical emergencies require quick field interventions and stabilization before transport, while rapid transportation to definitive healthcare with fewer field interventions improves trauma outcomes. Poor prehospital healthcare practices negatively impact patients' health, and limited studies exist on providers' practices in resource-limited areas like Ethiopia. This study aimed to assess the practice of pre-hospital emergency care and associated factors at pre-hospital health facilities in Addis Ababa, Ethiopia. Methods A facility-based cross-sectional study was conducted 191 pre-hospital healthcare providers, of which 20 randomly selected participants were participated in the observational study from October 2021 to February 2022 in Addis Ababa Ethiopia. Data was collected using a checklist and self-administered questionnaire. Data was cleaned, entered into Epi data version 4.4, and exported to SPSS software for analysis. Binary and multivariable logistic regression analyses were performed, with a P-value of 0.05 considered statistically significant. Results The study found that 43% (82) of pre-hospital healthcare providers in Addis Ababa, Ethiopia, had good practice in pre-hospital emergency care. The identified factors that increased the odds of good practice in pre-hospital emergency care were: being able to provide advanced life support (AOR = 88.99; 95% CI: 27.143-291.603); adequate monitoring and defibrillators (AOR = 5.829; 95% CI: 1.430-23.765); having work experience of 4-5 years (AOR = 5.86; 95% CI: 1.424-24.109); and having the opportunity to continue education (AOR = 31.953; 95% 6.479-157.591). Conclusions and Recommendations The study found high levels of poor practice among pre-hospital healthcare providers in Addis Ababa, Ethiopia. Factors contributing to good practice include being trained in advanced Life Support, adequate monitoring, defibrillators, work experience, and having the opportunity to continue education. Therefore, policymakers and health planners should establish teaching and training centres based on Ministry of Health and Education guidelines.
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Affiliation(s)
- Azanaw Abebe
- Schools of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Zegeye Kebede
- Schools of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Bhattarai HK, Bhusal S, Barone-Adesi F, Hubloue I. Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review. Prehosp Disaster Med 2023; 38:495-512. [PMID: 37492946 PMCID: PMC10445116 DOI: 10.1017/s1049023x23006088] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/08/2023] [Accepted: 06/17/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs. METHODS This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies. CONCLUSIONS The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure.
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Affiliation(s)
- Hari Krishna Bhattarai
- Program in Global Health, Humanitarian Aid and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy, and Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Francesco Barone-Adesi
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Ives Hubloue
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium Research Group on Emergency and Disaster Medicine, Medical School, Vrije Universiteit Brussel, Brussels, Belgium
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18
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Mamo AS, Gete BC, Shiferaw MA, Zeleke YG. Knowledge, Attitude, and Associated Factors towards Prehospital Care among Emergency Health Care Providers Working in Selected Prehospital Care Centers in Addis Ababa, Ethiopia: A Cross-Sectional Study. Prehosp Disaster Med 2023; 38:463-470. [PMID: 37345407 DOI: 10.1017/s1049023x23005915] [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] [Indexed: 06/23/2023]
Abstract
BACKGROUND Patients' health outcomes can suffer as a result of poor knowledge and unfavorable attitude towards prehospital emergency care. The purpose of this study was to assess emergency health care providers' (EHCPs') knowledge, attitude, and associated factors towards prehospital care in selected prehospital Emergency Medical Service institutions in Addis Abeba, Ethiopia. METHODS An institutional-based cross-sectional study design was conducted among EHCPs working in the three selected prehospital emergency medical care centers in Addis Ababa. Data were collected using a standard self-administered questionnaire, cleaned, coded, and entered into EPI Data Version 6, and then exported to SPSS Version 26 for further analysis. The generated data were compiled using frequency tables, charts, and percentages. Logistic regression analysis was used to see the association between independent and dependent variables. RESULTS One hundred thirty-five (135) study participants were included in this study, with a response rate of 95.7%. The mean age of the respondents was 29.2 years (SD = 4.86). Almost three-quarters of the respondents (71.1%) were aged between 26 and 35 years. Of the total participants, 58.5% and 62.2% of EHCPs had good knowledge and a favorable attitude towards prehospital care, respectively. The study revealed that profession (AOR = 3.2; 95% CI, 1.03 - 7.65), educational status (AOR = 1.17; 95% CI, 1.08 - 4.93), and having training (AOR = 2.25; 95% CI, 1.33 - 4.52) were significantly associated with the knowledge of EHCPs. This finding also revealed that the respondent's knowledge (AOR = 1.36; 95% CI, 1.05 - 2.32) and having training (AOR = 3.2; 95% CI, 1.24 - 7.83) were significantly associated with EHCPs' attitudes towards prehospital care. CONCLUSIONS The knowledge and attitude of EHCPs regarding prehospital care were found to be good and favorable as compared to previous studies. In-service training regarding emergency health conditions and the time needed to care for the patient is important for quality prehospital emergency medical care.
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Affiliation(s)
- Alemayehu Sileshi Mamo
- Department of Emergency and Critical Care, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Birhanu Chekol Gete
- Department of Emergency and Critical Care, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mehari Alemayehu Shiferaw
- Department of Emergency and Critical Care, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yared Getachew Zeleke
- Department of Emergency and Critical Care, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Kowark A, Felzen M, Ziemann S, Wied S, Czaplik M, Beckers SK, Brokmann JC, Hilgers RD, Rossaint R. Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial. Crit Care 2023; 27:256. [PMID: 37391836 PMCID: PMC10311733 DOI: 10.1186/s13054-023-04545-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND A tele-emergency medical service with a remote emergency physician for severe prehospital emergencies may overcome the increasing number of emergency calls and shortage of emergency medical service providers. We analysed whether routine use of a tele-emergency medical service is non-inferior to a conventional physician-based one in the occurrence of intervention-related adverse events. METHODS This open-label, randomised, controlled, parallel-group, non-inferiority trial included all routine severe emergency patients aged ≥ 18 years within the ground-based ambulance service of Aachen, Germany. Patients were randomised in a 1:1 allocation ratio to receive either tele-emergency medical service (n = 1764) or conventional physician-based emergency medical service (n = 1767). The primary outcome was the occurrence of intervention-related adverse events with suspected causality to the group assignment. The trial was registered with ClinicalTrials.gov (NCT02617875) on 30 November 2015 and is reported in accordance with the CONSORT statement for non-inferiority trials. RESULTS Among 3531 randomised patients, 3220 were included in the primary analysis (mean age, 61.3 years; 53.8% female); 1676 were randomised to the conventional physician-based emergency medical service (control) group and 1544 to the tele-emergency medical service group. A physician was not deemed necessary in 108 of 1676 cases (6.4%) and 893 of 1544 cases (57.8%) in the control and tele-emergency medical service groups, respectively. The primary endpoint occurred only once in the tele-emergency medical service group. The Newcombe hybrid score method confirmed the non-inferiority of the tele-emergency medical service, as the non-inferiority margin of - 0.015 was not covered by the 97.5% confidence interval of - 0.0046 to 0.0025. CONCLUSIONS Among severe emergency cases, tele-emergency medical service was non-inferior to conventional physician-based emergency medical service in terms of the occurrence of adverse events.
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Affiliation(s)
- Ana Kowark
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Marc Felzen
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Ziemann
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Stephanie Wied
- Department of Medical Statistics, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Czaplik
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefan K Beckers
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg C Brokmann
- Emergency Department, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Ralf-Dieter Hilgers
- Department of Medical Statistics, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany.
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Edmunds CT, Lachowycz K, McLachlan S, Downes A, Smith A, Major R, Barnard EBG. Nine golden codes: improving the accuracy of Helicopter Emergency Medical Services (HEMS) dispatch-a retrospective, multi-organisational study in the East of England. Scand J Trauma Resusc Emerg Med 2023; 31:27. [PMID: 37308937 DOI: 10.1186/s13049-023-01094-w] [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: 02/24/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) are a limited and expensive resource, and should be intelligently tasked. HEMS dispatch was identified as a key research priority in 2011, with a call to identify a 'general set of criteria with the highest discriminating potential'. However, there have been no published data analyses in the past decade that specifically address this priority, and this priority has been reaffirmed in 2023. The objective of this study was to define the dispatch criteria available at the time of the initial emergency call with the greatest HEMS utility using a large, regional, multi-organizational dataset in the UK. METHODS This retrospective observational study utilized dispatch data from a regional emergency medical service (EMS) and three HEMS organisations in the East of England, 2016-2019. In a logistic regression model, Advanced Medical Priority Dispatch System (AMPDS) codes with ≥ 50 HEMS dispatches in the study period were compared with the remainder to identify codes with high-levels of HEMS patient contact and HEMS-level intervention/drug/diagnostic (HLIDD). The primary outcome was to identify AMPDS codes with a > 10% HEMS dispatch rate of all EMS taskings that would result in 10-20 high-utility HEMS dispatches per 24-h period in the East of England. Data were analysed in R, and are reported as number (percentage); significance was p < 0.05. RESULTS There were n = 25,491 HEMS dispatches (6400 per year), of which n = 23,030 (90.3%) had an associated AMPDS code. n = 13,778 (59.8%) of HEMS dispatches resulted in patient contact, and n = 8437 (36.6%) had an HLIDD. 43 AMPDS codes had significantly greater rates of patient contact and/or HLIDD compared to the reference group. In an exploratory analysis, a cut-off of ≥ 70% patient contact rate and/or ≥ 70% HLIDD (with a > 10% HEMS dispatch of all EMS taskings) resulted in 17 taskings per 24-h period. This definition derived nine AMPDS codes with high HEMS utility. CONCLUSION We have identified nine 'golden' AMPDS codes, available at the time of initial emergency call, that are associated with high-levels of whole-system and HEMS utility in the East of England. We propose that UK EMS should consider immediate HEMS dispatch to these codes.
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Affiliation(s)
- Christopher T Edmunds
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK.
- University of East Anglia, Norwich, UK.
| | - Kate Lachowycz
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
- University of East Anglia, Norwich, UK
| | - Sarah McLachlan
- Essex & Herts Air Ambulance Trust, Colchester, Essex, UK
- Anglia Ruskin University, Cambridge, UK
| | - Andrew Downes
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
| | | | - Rob Major
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
- University of East Anglia, Norwich, UK
| | - Edward B G Barnard
- Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Gambling Close, Norwich Airport, Norwich, NR6 6EG, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Zhang B, Kang W, Xiong S, Huang X, Chen P, Huang J, Hou Y, Ma L, Xiang T. Changes in the epidemiological characteristics of prehospital emergency services before and during the COVID-19 pandemic, Chengdu, 2016-2021. Sci Rep 2023; 13:7796. [PMID: 37179377 PMCID: PMC10182747 DOI: 10.1038/s41598-023-34852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/09/2023] [Indexed: 05/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) brought a healthy crisis all around the world. It's not only affected healthcare utilization, but also some disease's incidence. We collected pre-hospital emergency data in Chengdu from January 2016 to December 2021, and studied the demand for emergency medical services (EMSs), emergency response times (ERTs), and the disease spectrum in the city proper of Chengdu as a whole. A total of 1,122,294 prehospital emergency medical service (EMS) instances met the inclusion criteria. Under the influence of COVID-19, notably in 2020, the epidemiological characteristics of prehospital emergency services in Chengdu were considerably altered. However, as the pandemic was brought under control, they returned to normal or even earlier in 2021.The COVID-19 pandemic had an effect on people's medical care-seeking behavior and the performance of prehospital emergency services. Although the indicators associated with prehospital emergency services eventually recovered as the epidemic was brought under control, they remained marginally different from before the outbreak.
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Affiliation(s)
- Bihua Zhang
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, China
- Department of Emergency, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No. 82 Qinglong Street, Chengdu, Sichuan, China
| | - Wenchao Kang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Shiqiang Xiong
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Xia Huang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Pei Chen
- Chengdu Medical Emergency Center, Chengdu, China
| | - Jinmin Huang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Yufei Hou
- Chengdu Medical Emergency Center, Chengdu, China
| | - Lin Ma
- Chengdu Medical Emergency Center, Chengdu, China
| | - Tao Xiang
- Department of Emergency, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No. 82 Qinglong Street, Chengdu, Sichuan, China.
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Al-Jaafreh A, Saifan AR, Mosleh SM, Al-Yateem N, Al-Momani MM. Experience of Health Professionals in Caring for Patients With Chest Trauma: A Qualitative Study. Dimens Crit Care Nurs 2023; 42:153-162. [PMID: 36996360 DOI: 10.1097/dcc.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The variation in the implementation of chest trauma (CT) management's guidelines led to inconsistent and mixed experiences toward CT management by the health care team. Moreover, there is a scarcity of studies exploring factors that enhance CT management experiences worldwide and in Jordan. OBJECTIVES The aims of this study were (1) to explore emergency health professionals' attitudes and experiences toward CT management and (2) to understand factors that affect the care for patients with CTs among emergency health professionals. METHODS A qualitative exploratory approach was adopted in this study. Individual, semistructured, face-to-face interviews were conducted with 30 emergency health professionals (physicians, nurses, and paramedics) from government emergency departments, military, private hospitals, and paramedics from the Civil Defense in Jordan. RESULTS The results showed that emergency health professionals had negative attitudes toward caring for patients with CTs due to a lack of knowledge and clarity in their job description and duties assigned to them. Moreover, some organizational and training factors were discussed for their impact on the attitudes of emergency health professionals toward caring for patients with CTs. CONCLUSIONS Lack of knowledge, absence of clear guidelines and job descriptions for dealing with traumas, and lack of continuous training on caring for patients with CTs were the most common reasons for negative attitudes. These findings can assist stakeholders, managers, and organizational leaders in understanding health care challenges and provoke a more focused strategic plan to diagnose and treat patients with CT.
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Descriptive Analysis of Clinical Encounters by Emergency Medical Services Physicians Using the RE-AIM Framework. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E58-E64. [PMID: 36214653 DOI: 10.1097/phh.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Emergency medical services (EMS) medicine continues to expand and mature as a recognized subspeciality within emergency medicine. In the United States, EMS physicians historically supported training, protocol development, and EMS clinician credentialing. In the past, only limited programs existed in which prehospital physicians were engaged in the direct and routine care of prehospital patients; however, a growing number of EMS programs are recognizing the value and impact of direct EMS physician involvement in prehospital patient care. PROGRAM A large suburban, volunteer-based EMS agency implemented a volunteer prehospital physician program where providers routinely responded to emergency calls for service. IMPLEMENTATION Beginning in November 2019, a cadre of board-certified physicians completed a field preceptorship and local protocol orientation. Once complete, the physicians were released to function and respond independently to high acuity emergency calls or any call at their discretion. Prehospital physicians were authorized to utilize their full scope of practice and expected to provide field mentorship to traditional prehospital clinicians. EVALUATION This study systematically evaluated a prehospital physician program for public health relevance, sustainability, and population health impact using the RE-AIM framework. A retrospective descriptive analysis was performed on the role and responses by a cohort of prehospital physicians using dispatch data and electronic medical records. DISCUSSION Over the 17-month study period, 9 prehospital physicians responded to 482 calls, predominately cardiac arrests, traumatic injuries, and cardiac/chest pain. The physicians performed 99 procedures and administered 113 medications. Ultimately, the program added physician-level care to the prehospital setting in an ongoing and sustainable way. The routine placement of physicians in the prehospital environment can help benefit patients by enhancing access to advanced clinical knowledge and skills, while also benefiting EMS clinicians through opportunities for enhanced patient-side training, education, and medical control.
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Fishe JN, Smotherman C, Burcham S, Martin-Gill C, Richards CT, Powell JR, Panchal AR, Salloum RG. Measuring the Implementation Preferences of Emergency Medical Services Clinicians Using Discrete Choice Experiments. PREHOSP EMERG CARE 2023; 28:381-389. [PMID: 36763470 PMCID: PMC10471772 DOI: 10.1080/10903127.2023.2177365] [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: 10/21/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Prehospital research and evidence-based guidelines (EBGs) have grown in recent decades, yet there is still a paucity of prehospital implementation research. While recent studies have revealed EMS agency leadership perspectives on implementation, the important perspectives and opinions of frontline EMS clinicians regarding implementation have yet to be explored in a systematic approach. The objective of this study was to measure the preferences of EMS clinicians for the process of EBG implementation and whether current agency practices align with those preferences. METHODS This study was a cross-sectional survey of National Registry of Emergency Medical Technicians registrants. Eligible participants were certified paramedics who were actively practicing EMS clinicians. The survey contained discrete choice experiments (DCEs) for three EBG implementation scenarios and questions about rank order preferences for various aspects of the implementation process. For the DCEs, we used multinomial logistic regression to analyze the implementation preference choices of EMS clinicians, and latent class analysis to classify respondents into groups by their preferences. RESULTS A total of 183 respondents completed the survey. Respondents had a median age of 39 years, were 74.9% male, 89.6% White, and 93.4% of non-Hispanic ethnicity. For all three DCE scenarios, respondents were significantly more likely to choose options with hospital feedback and individual-level feedback from EMS agencies. Respondents were significantly less likely to choose options with email/online only education, no feedback from hospitals, and no EMS agency feedback to clinicians. In general, respondents' preferences favored classroom-based training over in-person simulation. For all DCE questions, most respondents (66.2%-77.1%) preferred their survey DCE choice to their agency's current implementation practices. In the rank order preferences, most participants selected "knowledge of the underlying evidence behind the change" as the most important component of the process of implementation. CONCLUSIONS In this study of EMS clinicians' implementation preferences using DCEs, respondents preferred in-person education, feedback on hospital outcomes, and feedback on their individual performance. However, current practice at EMS agencies rarely matched those expressed EMS clinician preferences. Collectively, these results present opportunities for improving EMS implementation from the EMS clinician perspective.
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Affiliation(s)
- Jennifer N Fishe
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
- Prehospital Guidelines Consortium, Atlanta, Georgia
| | - Carmen Smotherman
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Shannon Burcham
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Christian Martin-Gill
- Prehospital Guidelines Consortium, Atlanta, Georgia
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christopher T Richards
- Prehospital Guidelines Consortium, Atlanta, Georgia
- Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Jonathan R Powell
- National Registry of Emergency Medical Technicians, Columbus, Ohio
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ashish R Panchal
- Prehospital Guidelines Consortium, Atlanta, Georgia
- National Registry of Emergency Medical Technicians, Columbus, Ohio
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
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Rahim F, Jain B, Patel T, Jain U, Jain P, Palakodeti S. Community Paramedicine: An Innovative Model for Value-Based Care Delivery. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E65-E68. [PMID: 36580427 DOI: 10.1097/phh.0000000000001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Faraan Rahim
- Duke University, Durham, North Carolina (Mr Rahim); Massachusetts Institute of Technology, Cambridge, Massachusetts (Mr B. Jain); University of Pennsylvania, Philadelphia, Pennsylvania (Mr Patel); University of Pittsburgh, Pittsburgh, Pennsylvania (Mr U. Jain); Highmark Health, Pittsburgh, Pennsylvania (Dr P. Jain); Indiana University of Pennsylvania, Indiana, Pennsylvania (Dr P. Jain); and Case Western Reserve University, Cleveland, Ohio (Dr Palakodeti)
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26
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Herttuainen A, Nordquist H. Recent Paramedic Graduates' Chronic Stress Adds Intentions to Leave the Profession: A Pilot Study Utilizing a Web-Based Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231210706. [PMID: 38014634 PMCID: PMC10685760 DOI: 10.1177/00469580231210706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023]
Abstract
Paramedics have mentally and physically demanding jobs, and chronic stress is not uncommon. Recently graduated paramedics, in particular, have been identified as needing support in their early careers. This pilot study examined chronic stress experienced by recent graduate paramedics and their intentions to leave the paramedic profession. Finnish paramedics encompass qualifications to work in various nursing sectors. This pilot study was a cross-sectional survey study among Finnish paramedics who graduated less than 3 years ago and who were currently working in prehospital EMS (n = 152). They evaluated chronic organizational and operational stressors on the Emergency Medical Services Chronic Stress Questionnaire with 20 statements. Two structured questions related to the intention to leave the paramedic profession. Three summary scales were formed. The differences in stress by the intention to leave were reported descriptively and the differences were tested with Mann-Whitney U test. The influence of potential predictors of the intention to leave prehospital EMS work or the nursing sector completely were explored with a forward stepwise logistic regression model. Those who intended to leave prehospital EMS work (25%, n = 35/152) or to leave the nursing sector completely (33%, n = 50/152) experienced higher levels of stress than those without such intentions. Stress related to organizational inequity and leadership challenges was the strongest and stress related to social, health, and personal impacts was the second strongest predictor of the intention to leave. Reducing chronic stress might be important in terms of paramedic retention. Several further study needs are addressed.
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Affiliation(s)
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
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27
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Effect of a Targeted Ambulance Treatment Quality Improvement Programme on Outcomes from Out-of-Hospital Cardiac Arrest: A Metropolitan Citywide Intervention Study. J Clin Med 2022; 12:jcm12010163. [PMID: 36614963 PMCID: PMC9820951 DOI: 10.3390/jcm12010163] [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: 10/31/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The performance of ambulance crew affects the quality of pre-hospital treatment, which is vital to the survival for out-of-hospital cardiac arrest (OHCA) patients, yet remains suboptimal in China. In this retrospective analysis study, we aimed to examine the effect of a citywide quality improvement programme on provision of prehospital advanced life support (ALS) by emergency medical service (EMS) system. EMS-treated adult OHCA patients after the implementation of the programme (1 January 2021 to 30 June 2022) were compared with historical controls (1 June 2019 to 31 August 2020) in Suzhou. Multivariable logistic regression analysis and propensity score matching procedures were applied to compare the outcomes between two periods for total OHCA cases and subgroup of cases treated by fixed or non-fixed ambulance crews. A total of 1465 patients (pre-period/post-period: 610/855) were included. In the 1:1 matched analysis of 591 cases for each period, significant improvement (p < 0.05) was observed for the proportion of intravenous (IV) access (23.4% vs. 68.2%), advanced airway management (49.2% vs. 57.0%), and return of spontaneous circulation (ROSC) at handover (5.4% vs. 9.0%). The fixed ambulance crews performed better than non-fixed group in IV access and advanced airway management for both periods. There were significant increases in IV access (AOR 12.66, 95%CI 9.02−18.10, p < 0.001), advanced airway management (AOR 1.67, 95% CI 1.30−2.16, p < 0.001) and ROSC at handover (AOR 2.37, 95%CI 1.38−4.23, p = 0.002) after intervention in unfixed group, while no significant improvement was observed in fixed group except for IV access (AOR 7.65, 95%CI 9.02−18.10, p < 0.001). In conclusion, the quality improvement program was positively associated with the provision of prehospital ALS interventions and prehospital ROSC following OHCA. The fixed ambulance crews performed better in critical care provision and prehospital outcome, yet increased protocol adherence and targeted training could fill the underperformance of non-fixed crews efficaciously.
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28
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Pre-hospital guidelines for CPR-Induced Consciousness (CPRIC): A scoping review. Resusc Plus 2022; 12:100335. [DOI: 10.1016/j.resplu.2022.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
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Fürst B, Thiaener A, Schroll A, Adler D, Gradl G. Erfolgreiche innerklinische Clamshell-Thorakotomie bei einem jungen polytraumatisierten (ISS 57) Patienten. Unfallchirurg 2022; 126:316-321. [PMID: 35499763 DOI: 10.1007/s00113-022-01183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Life-threatened injured patients who suffer a cardiovascular arrest after a trauma are still enormously challenging for both the paramedics and the trauma team in the clinic. This case illustrates the treatment of a 16-year-old boy who suffered a blunt abdominal trauma with a traumatic cardiac arrest followed by an open resuscitation after clamshell thoracotomy. Subsequently, the treatment after damage control is discussed regarding the current literature and recommendations for treatment.
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Affiliation(s)
- Benedikt Fürst
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland.
| | - Axel Thiaener
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
| | - Andreas Schroll
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
| | - Daniel Adler
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
| | - Georg Gradl
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
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30
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Renza M, Sykora R, Peran D, Hricova K, Brizgalova N, Bakurova P, Kukacka M. Pilot implementation of the competence of Czech paramedics to administer sufentanil for the treatment of pain in acute trauma without consulting a physician: observational study. BMC Emerg Med 2022; 22:63. [PMID: 35397498 PMCID: PMC8994188 DOI: 10.1186/s12873-022-00622-8] [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: 10/04/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background The use of intravenous opioids in the traumatic pain in pre-hospital care in the Czech Republic is based primarily on the indication of a physician. If the paramedic crew arrives at the site earlier or only on their own, analgesia is given after phone-call consultation with the physician or after his arrival at the site. The objective of this study was to evaluate the safety and efficacy of the indication and administration of sufentanil by paramedics in the treatment of pain in acute trauma adult patients without the physician’s control. Methods Paramedics underwent voluntarily the simulation training aimed at administering intravenously sufentanil to treat pain in acute trauma in adults without physician’s indication. Subsequently, the adverse events and efficacy were monitored for a six-month period and compared in two groups: administration of sufentanil by paramedics without this competence, who further consulted the administration by telephone with physicians (group Consultation) and those with this competence (group Competence). Results A total number of sufentanil administration in group Consultation was 88 and in group Competence 70. There was no respiratory arrest, bradypnea, or need for oxygen therapy reported in any of the study groups. The incidence of nausea was 3% in both groups – Consultation (n = 3) and in Competence (n = 2). Vomiting was not reported in the Consultation group and in 6% in the Competence group (n = 4). Intravenous antiemetic drugs were used in the Consultation group only in 1% (n = 1) and in the Competence group in 7% of patients (n = 5) (p < 0,05). In both groups there was observed a decrease in the pain numeric rating scale (Consultation: M =—3,2; SD = 1,2 points vs. Competence: M =—3,9; SD = 1,8 points). Conclusion Intravenous administration of sufentanil by properly trained paramedics without consultation with a physician in acute trauma can be considered safe.
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31
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Wang S, Xia D, Zhang Z, Zhang J, Meng W, Zhang Y, Xu S. Mapping Trends and Hotspots Regarding the Use of Ultrasound in Emergency Medicine: A Bibliometric Analysis of Global Research. Front Public Health 2022; 9:764642. [PMID: 35004578 PMCID: PMC8739757 DOI: 10.3389/fpubh.2021.764642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Diagnostic tools in emergency medicine have been widely studied. As a non-invasive and quick tool, ultrasound plays a role in the field of emergency medicine. Thus, it is significant to understand the global scientific output of this topic. An analysis of publications on the use of ultrasound in emergency medicine over the past decade was performed and summarized to track the current hotspots and highlight future directions. Methods: Globally relevant publications on ultrasound in emergency medicine from 2009 to 2020 were extracted from the Web of Science collection database. VOSviewer software and CiteSpace were employed to visualize and predict the trends in the research on the topic. Results: The overall volume of global publications is on the rise; furthermore, the United States published the most publications in this field and had the most citations and H-index. University of California at San Francisco in the United States has most publications in terms of institutions. The American Journal of Emergency Medicine published the most papers related to ultrasound in emergency medicine in terms of journals. Pulmonary embolism was once the main research direction, and importantly, “point-of-care ultrasound” was determined to be a new research hotspot. Conclusion: Altogether, the number of publications on ultrasound in emergency medicine will rise in the future. In addition, the findings reported here shed new light on the major progress on ultrasound in emergency medicine, which may be mutually cooperative in various fields. Moreover, this bibliometric study provides further indications for the topic of “point-of-care ultrasound”.
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Affiliation(s)
- Sheng Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Demeng Xia
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.,Health Clinic, People's Liberation Army Unit 91666, Zhoushan, China
| | - Zhentao Zhang
- Department of Clinical Medicine, Naval Medical University, Shanghai, China
| | - Jingli Zhang
- Department of Neurology Rehabilitation, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Wenhao Meng
- Department of Clinical Medicine, Wei Fang Medical University, Wei Fang, China
| | - Yanping Zhang
- Nanjing Comprehensive Stroke Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Shuogui Xu
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
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Bredmose PP, Hooper J, Viggers S, Linde J, Reid C, Grier G, Mazur S. Prehospital Care: An International Comparison of Independently Developed Training Courses. Air Med J 2022; 41:73-77. [PMID: 35248348 DOI: 10.1016/j.amj.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/18/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prehospital and retrieval medicine (PHRM) occurs in a complex work environment. Appropriate training is essential to ensure high standards of clinical care and logistic decision making. Before commencing the role, PHRM doctors have varying levels of experience. This narrative review article aims to describe and compare 6 internationally accepted PHRM courses. METHODS Six PHRM course directors were asked to describe their course in terms of education methods used, course content, and assessment processes. Each of the directors contributed to the discussion process. RESULTS Although developed independently, all 6 courses use a comparable combination of lectures, simulations, and discussion groups. The amount of each pedagogical modality varies between the courses. CONCLUSION We have identified significant similarities and some important differences among some well-accepted independently developed PHRM courses worldwide. Differences in content and the methods of delivery appear linked to the background of participants and service case mix. The authors believe that even in the small niche of PHRM, courses need to be tailored to the participants and the "destination of the participants" (ie, where they are going to use their skills).
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Affiliation(s)
- Per P Bredmose
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Norwegian Air Ambulance Foundation, Drøbak, Norway; LifeFlight Retrieval Medicine, Queensland, Australia.
| | - Jeff Hooper
- LifeFlight Retrieval Medicine, Queensland, Australia
| | - Sandra Viggers
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Joacim Linde
- Swedish Air Ambulance, Gothenburg, SLA, Sweden, Gothenburg
| | - Cliff Reid
- NSW Ambulance Aeromedical Operations, Sydney, Australia
| | | | - Stefan Mazur
- SAAS MedSTAR, Emergency Medical Retrieval, Adelaide, Australia
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Park CL, Grier GR. Provision of pre-hospital medical care for terrorist attacks. Br J Anaesth 2021; 128:e85-e89. [PMID: 34903363 DOI: 10.1016/j.bja.2021.10.023] [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: 08/06/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
The delivery of medical care to the severely injured during major incidents and mass casualty events has been a recurring challenge for decades across the world. From events in resource-poor developing countries, through richly funded military conflicts, to the most equipped of developed nations, the provision of rapid medical care to the severely injured during major incidents and mass casualty events has been a priority for healthcare providers. This is often under the most difficult of circumstances.1,2 Whilst mass casualty events are a persistent global challenge, it is clear in developed countries that patients and their families demand and expect a high standard of care from their rescuers, that this care should be delivered rapidly, and this should be of the highest quality possible.3 Whilst there is respect afforded to those who 'run towards danger' during a high-threat situation, first responders are subjected to a high degree of scrutiny for their actions, even when the circumstances they are presented with are considered to be extraordinary.4 Likewise, even for those who are catastrophically injured beyond salvage, society expects the response to be dignified, calculated, and thorough.3.
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Affiliation(s)
- Claire L Park
- Barts Health NHS Trust, London, UK; King's College Hospital NHS Trust, London, UK; Institute of Pre-Hospital Care at London's Air Ambulance, London, UK; Specialist Firearms Department of the Metropolitan Police Service, London, UK.
| | - Gareth R Grier
- Barts Health NHS Trust, London, UK; Institute of Pre-Hospital Care at London's Air Ambulance, London, UK; Queen Mary University London, London, UK
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Stevens J, Price J, Hazlerigg A, McLachlan S, Barnard EBG. Comparison of deliberate self-harm incidents attended by Helicopter Emergency Medical Services before and during the first wave of COVID-19 in the East of England. Emerg Med J 2021; 38:842-845. [PMID: 34556538 DOI: 10.1136/emermed-2020-210393] [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: 07/13/2020] [Accepted: 09/10/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is significant interest in the mental health impact of the COVID-19 pandemic. Helicopter Emergency Medical Services (HEMS) attend the most seriously unwell and injured patients in the community; their data therefore present an early opportunity to examine self-harm trends. The primary aim was to compare the incidence of deliberate self-harm incident (DSH-I) encounters by HEMS before and during the first wave of COVID-19. METHODS Data were obtained from all three East of England HEMS: total number of activations and stand-downs, number of DSH-I activations and stand-downs, self-harm mechanism and number of 'severe' DSH-I patient encounters, in two 61-day periods: 1 March to 30 April in 2019 (control) and 2020 (COVID-19). Severe DSH-I was defined as cardiac arrest and/or died prehospital. Proportions were compared with a Fisher's exact test. RESULTS There were a total of 1725 HEMS activations: n=981 (control) and n=744 (COVID-19), a decrease of 24.2% during COVID-19. DSH-I patient encounters increased by 65.4%: n=26 (control) and n=43 (COVID-19). The proportion of encounters that were DSH-I and severe DSH-I both significantly increased during COVID-19: p=0.002 and p=0.001, respectively. The absolute number of hangings and falls from height both approximately tripled during COVID-19, whereas the number of other mechanisms remained almost constant. CONCLUSION Despite a reduction in overall HEMS patient encounters, there were significant increases in both the proportion of DSH-Is and their severity attended by HEMS during the first wave of the COVID-19 pandemic in the East of England.
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Affiliation(s)
- Joanna Stevens
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich, UK .,Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Price
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich, UK.,Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Magpas Air Ambulance, Huntingdon, UK
| | - Antonia Hazlerigg
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Magpas Air Ambulance, Huntingdon, UK
| | - Sarah McLachlan
- Research Department, Essex and Herts Air Ambulance, Earls Colne, Colchester, UK.,Department of Allied Health and Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Ed Benjamin Graham Barnard
- Department of Research, Audit, Innovation and Development, East Anglian Air Ambulance, Norwich, UK.,Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Zhu H, Pan L, Li Y, Jin H, Wang Q, Liu X, Wang C, Liao P, Jiang X, Li L. Spatial Accessibility Assessment of Prehospital EMS with a Focus on the Elderly Population: A Case Study in Ningbo, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199964. [PMID: 34639264 PMCID: PMC8508414 DOI: 10.3390/ijerph18199964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
The spatial accessibility of prehospital EMS is particularly important for the elderly population’s physiological functions. Due to the recent expansion of aging populations all over the globe, elderly people’s spatial accessibility to prehospital EMS presents a serious challenge. An efficient strategy to address this issue involves using geographic information systems (GIS)-based tools to evaluate the spatial accessibility in conjunction with the spatial distribution of aging people, available road networks, and prehospital EMS facilities. This study employed gravity model and empirical Bayesian Kriging (EBK) interpolation analysis to evaluate the elderly’s spatial access to prehospital EMS in Ningbo, China. In our study, we aimed to solve the following specific research questions: In the study area, “what are the characteristics of the prehospital EMS demand of the elderly?” “Do the elderly have equal and convenient spatial access to prehospital EMS?” and “How can we satisfy the prehospital EMS demand of an aging population, improve their spatial access to prehospital EMS, and then ensure their quality of life?” The results showed that 37.44% of patients admitted to prehospital EMS in 2020 were 65 years and older. The rate of utilization of ambulance services by the elderly was 27.39 per 1000 elderly residents. Ambulance use by the elderly was the highest in the winter months and the lowest in the spring months (25.90% vs. 22.38%). As for the disease spectrum, the main disease was found to be trauma and intoxication (23.70%). The mean accessibility score was only 1.43 and nearly 70% of demand points had scored lower than 1. The elderly’s spatial accessibility to prehospital EMS had a central-outward gradient decreasing trend from the central region to the southeast and southwest of the study area. Our proposed methodology and its spatial equilibrium results could be taken as a benchmark of prehospital care capacity and help inform authorities’ efforts to develop efficient, aging-focused spatial accessibility plans.
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Affiliation(s)
- Huanhuan Zhu
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Lin Pan
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yiji Li
- Ningbo Medical Emergency Center, Ningbo 315000, China; (Y.L.); (H.J.)
| | - Huiming Jin
- Ningbo Medical Emergency Center, Ningbo 315000, China; (Y.L.); (H.J.)
| | - Qian Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xin Liu
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Cong Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Peng Liao
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xinyang Jiang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Luo Li
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
- Correspondence:
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Yamamoto R, Suzuki M, Yoshizawa J, Nishida Y, Junichi S. Physician-staffed ambulance and increased in-hospital mortality of hypotensive trauma patients following prolonged prehospital stay: A nationwide study. J Trauma Acute Care Surg 2021; 91:336-343. [PMID: 33852563 DOI: 10.1097/ta.0000000000003239] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The benefits of physician-staffed emergency medical services (EMS) for trauma patients remain unclear because of the conflicting results on survival. Some studies suggested potential delays in definitive hemostasis due to prolonged prehospital stay when physicians are dispatched to the scene. We examined hypotensive trauma patients who were transported by ambulance, with the hypothesis that physician-staffed ambulances would be associated with increased in-hospital mortality, compared with EMS personnel-staffed ambulances. METHODS A retrospective cohort study that included hypotensive trauma patients (systolic blood pressure ≤ 90 mm Hg at the scene) transported by ambulance was conducted using the Japan Trauma Data Bank (2004-2019). Physician-staffed ambulances are capable of resuscitative procedures, such as thoracotomy and surgical airway management, while EMS personnel-staffed ambulances could only provide advanced life support. In-hospital mortality and prehospital time until the hospital arrival were compared between patients who were classified based on the type of ambulance. Inverse probability weighting was conducted to adjust baseline characteristics including age, sex, comorbidities, mechanism of injury, vital signs at the scene, injury severity, and ambulance dispatch time. RESULTS Among 14,652 patients eligible for the study, 738 were transported by a physician-staffed ambulance. In-hospital mortality was higher in the physician-staffed ambulance than in the EMS personnel-staffed ambulance (201/699 [28.8%] vs. 2287/13,090 [17.5%]; odds ratio, 1.90 [1.61-2.26]; adjusted odds ratio, 1.22 [1.14-1.30]; p < 0.01), and the physician-staffed ambulance showed longer prehospital time (50 [36-66] vs. 37 [29-48] min, difference = 12 [11-12] min, p < 0.01). Such potential harm of the physician-staffed ambulance was only observed among patients who arrived at the hospital with persistent hypotension (systolic blood pressure < 90 mm Hg on hospital arrival) in subgroup analyses. CONCLUSION Physician-staffed ambulances were associated with prolonged prehospital stay and increased in-hospital mortality among hypotensive trauma patients compared with EMS personnel-staffed ambulance. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Ryo Yamamoto
- From the Department of Emergency and Critical Care Medicine (R.Y., J.Y., Y.N., J.S.), Keio University School of Medicine, Tokyo; and Department of Emergency Medicine (M.S.), Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
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Jansson J, Larsson M, Nilsson J. Advanced paramedics and nurses can deliver safe and effective pre-hospital and in-hospital emergency care: An integrative review. Nurs Open 2021; 8:2385-2405. [PMID: 33955702 PMCID: PMC8363369 DOI: 10.1002/nop2.866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/05/2022] Open
Abstract
AIM To explore and present an overview of scope of practice among registered nurses and paramedics with an advanced level of education in pre-hospital and in-hospital emergency care. DESIGN An integrative literature review. METHOD Studies published between 2006 and 2018 were retrieved by searching the databases CINAHL, PubMed, Scopus and Web of Science. Studies were selected by three independent researchers, and data were synthesized using thematic analysis. RESULTS The 25 studies identified focused on in-hospital (n = 15) and pre-hospital emergency care (n = 10) and included 13 professional titles originated from seven countries. The thematic analysis disclosed four themes; "Versatile care," "Safe care based on precision and accuracy," "Autonomous performance within boundaries" and "Beneficial towards patients and society." Advanced paramedics' and advanced nurses' services are characterized as safe, of high quality and of public benefit. Their services are being used in everyday practice as well as directed to certain categories of patients.
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Affiliation(s)
- Jörgen Jansson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Maria Larsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Bredmose PP, Stave H, Eriksen M, Osbakk SA, Farstad G, Hagemo JS. Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews. Air Med J 2021; 40:60-64. [PMID: 33455629 DOI: 10.1016/j.amj.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures. METHODS Participants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants' perception of any change in their skills as a result of the course. RESULTS The self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P < .001). CONCLUSION Experienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models.
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Affiliation(s)
- Per P Bredmose
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.
| | - Halvard Stave
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Morten Eriksen
- Institute for Experimental Medical Research, Section for Preclinical Physiology, Oslo University Hospital, Oslo, Norway
| | - Svein Are Osbakk
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Gunnar Farstad
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Jostein S Hagemo
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
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Tang KJW, Ang CKE, Constantinides T, Rajinikanth V, Acharya UR, Cheong KH. Artificial Intelligence and Machine Learning in Emergency Medicine. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abate H, Mekonnen C. Knowledge, Practice, and Associated Factors of Nurses in Pre-Hospital Emergency Care at a Tertiary Care Teaching Hospital. Open Access Emerg Med 2020; 12:459-469. [PMID: 33408536 PMCID: PMC7781023 DOI: 10.2147/oaem.s290074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pre-hospital emergency care is a medical care given to patients before arrival in the hospital after activation of the emergency team. Poor knowledge and practice about pre-hospital emergency care hurt the health outcomes of the patients. OBJECTIVE This study aimed to assess knowledge and practice nurses at the University of Gondar Compressive Specialized Hospital, Northwest Ethiopia. METHODS An institutional-based cross-sectional study was conducted from March 20 to April 10, 2020. A stratified sampling technique was used to select the study participants. Data were collected using a pretested structured self-administered questionnaire. Data were analyzed using SPSS version 20. To explain study variables, frequency tables and percentages were used. Logistic regression analysis was used to see the association between independent and dependent variables. RESULTS Out of the total 378 respondents, less than half (42.9%) had good knowledge; similarly, 49.5% of them had good practice about pre-hospital emergency care. Male sex and attend formal training were significant associations with both knowledge and practice of pre-hospital emergency nursing care. Male participants (adjusted odds ratio (AOR) = 6.57, 95% confidence interval (CI) (3.79-11.36)) and having training (AOR=1.74, 95% CI (1.83-3.66)) were significantly associated with knowledge of pre-hospital emergency care, whereas male sex (AOR=1.73, 95% CI (1.09-2.73)) and having training (AOR=6.16, 95% CI (2.69-14.10)) were significantly associated with the practice of pre-hospital emergency care. CONCLUSION Knowledge and practice of nurses regarding pre-hospital emergency care was found to be inadequate as compared to previous studies. Male sex and attend formal training showed a positive and significant association with both knowledge and practice of pre-hospital emergency nursing care. The responsible body ought to allow professional development and attending formal training for nurses.
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Affiliation(s)
- Hailemichael Abate
- Department of Medical Nursing, College of Health Science, Gondar, Ethiopia
| | - Chilot Mekonnen
- Department of Medical Nursing, College of Health Science, Gondar, Ethiopia
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Eklund A, Saveman BI, Gyllencreutz L. Situational awareness during a full-scale exercise in an underground mine: A qualitative single-case study of the ambulance incident commander. Int Emerg Nurs 2020; 54:100950. [PMID: 33326908 DOI: 10.1016/j.ienj.2020.100950] [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: 07/02/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Underground environments present challenges for providing and managing effective emergency care. Situational awareness (SA) has been suggested as a critical process to the management of care. AIM This study aims to explore the process of SA in the tasks of an ambulance incident commander (AIC) during a fullscale underground mine exercise. METHODS Data consisted of video recordings, audiotapes and fieldnotes; these were subjected to content analysis based on the categories from the Busby Theory of Situational Awareness in Multi-casualty Incidents. RESULTS The results show that the underground mining environment presented the AIC with specific challenges for the SA process with respect to aspects such as situational information about the scene and the victims, as well as with making decisions for ambulance personnel so they could perform their work safely, and having a structured manner to counteract information overload. Both technical and non-technical aspects influenced the process. CONCLUSION The AIC's situational awareness was largely built through coordinated communications and actions with collaborating actors. The results of this study can be used for further exploration of how to train and support people in medical leadership roles on aspects of SA in emergency care, as well as on how to evaluate educational outcomes through exercises.
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Affiliation(s)
- Annika Eklund
- Department of Health Sciences, Section for Advanced Nursing, University West, 461 86 Trollhättan, Sweden.
| | - Britt-Inger Saveman
- Department of Surgery and Perioperative Sciences, Section for Surgery, Umeå University, 901 87 Umeå, Sweden; Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
| | - Lina Gyllencreutz
- Department of Surgery and Perioperative Sciences, Section for Surgery, Umeå University, 901 87 Umeå, Sweden; Department of Nursing, Umeå University, 901 87 Umeå, Sweden.
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Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial. Prehosp Disaster Med 2020; 35:656-662. [PMID: 32985403 DOI: 10.1017/s1049023x2000117x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The effect and subjective perception of audiovisual consults (AVCs) by paramedics with a distant physician in prehospital emergency care (PHEC) remain unexplained, especially in low-urgency calls. OBJECTIVES The primary objective of the study was to evaluate the effect of AVCs by paramedics with a base physician on the rate of patients treated on site without the need of hospital transfer. The co-primary safety outcome was the frequency of repeated ambulance trips within 48 hours to the same patient. Secondary objective was the qualitative analysis of perception of the AVCs. METHODS During a six-week period, the dispatching center of Karlovy Vary Emergency Medical Service (EMS) randomized low-urgency events from a rural area (n = 791) to receive either a mandatory phone-call consult (PHONE), AVC (VIDEO), or performed by the paramedic crew in a routine manner, when phone-call consultation is for paramedic crew optional (CONTROL). Secondarily, the qualitative analysis of subjective perception of AVCs compared to consultation over the phone by the paramedic and consulting physician was performed. RESULTS Per-protocol analysis (PPA) was performed (CONTROL, n = 258; PHONE, n = 193; and VIDEO, n = 192) in addition to the intention-to-treat (ITT) analysis. Patients (PPA) in both mandatory consulted groups were twice as likely to be treated and left on site compared to the CONTROL (PHONE: OR = 2.07; 95% CI, 1.19 to 3.58; P = 0.01 or VIDEO: OR = 2.01; 95% CI, 1.15 to 3.49; P = .01). Repeated trips to patients treated and left on site in 48 hours occurred in three (8.6%) of 35 cases in the PHONE group and in eight (23.5%) of 34 cases in the VIDEO group. CONCLUSIONS The AVCs of the emergency physician by paramedics was not superior to the mandatory conventional phone call in increasing the proportion of patients treated and left at home after a low-urgency call. The AVC improved the subjective feelings of safety by physicians, but not the satisfaction of patients or paramedics, and may lead to an increased need of repeated trips.
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Heffernan E, Oving I, Barry T, Phung VH, Siriwardena AN, Masterson S. Factors that motivate individuals to volunteer to be dispatched as first responders in the event of a medical emergency: A systematic review protocol. HRB Open Res 2020; 2:34. [PMID: 32490350 PMCID: PMC7236422 DOI: 10.12688/hrbopenres.12969.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Voluntary First Response is an important component of prehospital care for medical emergencies, particularly cardiac arrest, in many countries. This intervention entails the mobilisation of volunteers, known as Community First Responders (CFRs), by the Emergency Medical Services to respond to medical emergencies in their locality. They include lay responders and/or professional responders (e.g. police officers, fire fighters, and general practitioners). A wide variety of factors are thought to motivate CFRs to join and remain engaged in Voluntary First Response schemes, such as the availability of learning opportunities, recognition, counselling, and leadership. The aim of this review is to develop an in-depth understanding of CFR motivation, including the factors that influence the initial decision to volunteer as a CFR and the factors that sustain involvement in Voluntary First Response over time. Any factors relevant to CFR de-motivation and turnover will also be examined. Methods: This is a protocol for a qualitative systematic review of the factors that influence the motivation of individuals to participate in Voluntary First Response. A systematic search will be carried out on seven electronic databases. Qualitative studies, mixed-methods studies, and any other studies producing data relating to the review question will be eligible for inclusion. Title and abstract screening, as well as full text screening, will be completed independently by two authors. A narrative synthesis, which is an established qualitative synthesis methodology, will be performed. The quality of each of the included studies will be critically appraised. Discussion: The findings of this review will be used to optimise the intervention of Voluntary First Response. Specifically, the results will inform the design and organisation of Voluntary First Response schemes, including their recruitment, training, and psychological support processes. This could benefit a range of stakeholders, including CFRs, paramedics, emergency physicians, patients, and the public.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
| | - Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Viet-Hai Phung
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
- National Ambulance Service, Health Service Executive, St. Eunan's Hall, St Conal's Hospital, Letterkenny, Donegal, F92 XK84, Ireland
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Füzéry AK, Bobyak J, Chang E, Sharman R, Venner AA. Challenges of Point-of-Care Testing in Ambulances. J Appl Lab Med 2020; 4:293-295. [PMID: 31639680 DOI: 10.1373/jalm.2019.029439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/23/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Anna K Füzéry
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada; .,Alberta Public Laboratories Ltd., Alberta, Canada
| | | | - Eddie Chang
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada.,Shock Trauma Air Rescue Service (STARS), Edmonton, Canada
| | - Robert Sharman
- Shock Trauma Air Rescue Service (STARS), Edmonton, Canada
| | - Allison A Venner
- Alberta Public Laboratories Ltd., Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
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Chiapuzio C, Dang T, Meagher S, Woodward B, Neeki M. The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation. Cureus 2020; 12:e10405. [PMID: 32944485 PMCID: PMC7489765 DOI: 10.7759/cureus.10405] [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] [Indexed: 11/12/2022] Open
Abstract
Trauma is the leading cause of morbidity and mortality for those under 45 years of age in the United States with half of the deaths in trauma being attributed to hemorrhagic shock. The use of enhanced care teams (ECTs) that include physicians in selective prehospital settings has allowed the delivery of advanced critical care interventions in the field. We present a unique case where a young driver involved in a motor vehicle accident was trapped under the weight of his vehicle, causing extended extrication time. An ECT from the closest trauma center was able to deliver massive transfusion and definitive airway care while the patient was being extricated. While previous literature regarding the benefit of ECTs has been debated, this case suggests a unique niche where rapid deployment of an ECT to the scene made a pronounced difference in survival of the patient.
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Affiliation(s)
| | - Thomas Dang
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Shannon Meagher
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Michael Neeki
- Emergency Medicine, California University of Science and Medicine, Colton, USA.,Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
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In situ simulation training in helicopter emergency medical services: feasible for on-call crews? Adv Simul (Lond) 2020; 5:7. [PMID: 32550015 PMCID: PMC7294664 DOI: 10.1186/s41077-020-00126-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
Simulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ simulation that can be carried out during on-call time. The aim of this study is to investigate the feasibility of introducing in situ, simulation-based training for the on-call team on a busy helicopter emergency medical service (HEMS) base. We carried out a one-year prospective study on simulation training during active duty at a busy Norwegian HEMS base, which has two helicopter crews on call 24/7. Training was conducted as low fidelity in situ simulation while the teams were on call. The training took place on or near the HEMS base. Eight scenarios were developed with learning objectives related to the mission profile of the base which includes primary missions for both medical and trauma patients of all ages, and interhospital transport of adults, children, and neonates. All scenarios included learning objectives for non-technical skills. A total of 44 simulations were carried out. Total median (quartiles) time consumption for on-call HEMS crew was 65 (59-73) min. Time for preparation of scenarios was 10 (5-11) min, time for simulations was 20 (19-26) min, cleaning up 7 (6-10) min, and debrief 35 (30-40) min. For all items on the questionnaire, the majority of respondents replied with the two most positive categories on the Likert scale. Our results demonstrate that in situ simulation training for on-call crews on a busy HEMS base is feasible with judicious investment of time and money. The participants were very positive about their experience and the impact of this type of training.
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Influence of prehospital physician presence on survival after severe trauma: Systematic review and meta-analysis. J Trauma Acute Care Surg 2020; 87:978-989. [PMID: 31335754 DOI: 10.1097/ta.0000000000002444] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND As trauma is one of the leading causes of death worldwide, there is great potential for reducing mortality in trauma patients. However, there is continuing controversy over the benefit of deploying emergency medical systems (EMS) physicians in the prehospital setting. The objective of this systematic review and meta-analysis is to assess how out-of-hospital hospital management of severely injured patients by EMS teams with and without physicians affects mortality. METHODS PubMed and Google Scholar were searched for relevant articles, and the search was supplemented by a hand search. Injury severity in the group of patients treated by an EMS team including a physician had to be comparable to the group treated without a physician. Primary outcome parameter was mortality. Helicopter transport as a confounder was accounted for by subgroup analyses including only the studies with comparable modes of transport. Quality of all included studies was assessed according to the Cochrane handbook. RESULTS There were 2,249 publications found, 71 full-text articles assessed, and 22 studies included. Nine of these studies were matched or adjusted for injury severity. The odds ratio (OR) of mortality was significantly lower in the EMS physician-treated group of patients: 0.81; 95% confidence interval (CI): 0.71-0.92. When analysis was limited to the studies that were adjusted or matched for injury severity, the OR was 0.86 (95% CI, 0.73-1.01). Analyzing only studies published after 2005 yielded an OR for mortality of 0.75 (95% CI, 0.64-0.88) in the overall analysis and 0.81 (95% CI, 0.67-0.97) in the analysis of adjusted or matched studies. The OR was 0.80 (95% CI, 0.65-1.00) in the subgroup of studies with comparable modes of transport and 0.74 (95% CI, 0.53-1.03) in the more recent studies. CONCLUSION Prehospital management of severely injured patients by EMS teams including a physician seems to be associated with lower mortality. After excluding the confounder of helicopter transport we have shown a nonsignificant trend toward lower mortality. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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Nakao S, Katayama Y, Kitamura T, Hirose T, Sado J, Ishida K, Tachino J, Umemura Y, Kiguchi T, Matsuyama T, Kiyohara K, Shimazu T. Epidemiological profile of emergency medical services in Japan: a population-based descriptive study in 2016. Acute Med Surg 2020; 7:e485. [PMID: 32015883 PMCID: PMC6992505 DOI: 10.1002/ams2.485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/13/2019] [Accepted: 12/25/2019] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of our study is to describe the characteristics of patients who use emergency medical services (EMS), EMS performance, and regional variations in Japan. Methods We undertook a nationwide, population‐based, descriptive review of anonymized ambulance transport records obtained from the Fire and Disaster Management Agency in Japan. All emergency patients transported to emergency medical institutions by EMS personnel from January to December 2016 were enrolled in this study, excluding patients who were not transported. Results During the study period, 5,097,838 patients were transported to a hospital. Their median age was 69 years, 51.4% were male, and 56.5% were over 65 years old. Median durations from EMS call to EMS arrival on scene were similar among the regions, ranging from 7 to 9 min. However, the longest median duration from EMS call to hospital arrival was 38 min, and the shortest was 31 min across the regions. Among all patients, 350,865 (6.9%) were assessed as being in a severe condition, 14,410 (0.3%) were in very severe condition, and 74,780 (1.5%) were confirmed to be dead at the time of initial medical examination in the emergency department. Conclusions We described the characteristics of emergency patients and EMS performance in Japan. This registry serves as a basis for providing relevant information to improve prehospital emergency medical systems.
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Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan.,Emergency and Critical Care Center Osaka Police Hospital Osaka Japan
| | - Junya Sado
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center Osaka National Hospital National Hospital Organization Osaka Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Yutaka Umemura
- Department of Emergency and Critical Care Osaka General Medical Center Osaka Japan
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan
| | - Kosuke Kiyohara
- Department of Food Science Faculty of Home Economics Otsuma Women's University Tokyo Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
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Heffernan E, Oving I, Barry T, Phung VH, Siriwardena AN, Masterson S. Factors that motivate individuals to volunteer to be dispatched as first responders in the event of a medical emergency: A systematic review protocol. HRB Open Res 2019; 2:34. [PMID: 32490350 PMCID: PMC7236422 DOI: 10.12688/hrbopenres.12969.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 01/21/2024] Open
Abstract
Background: Voluntary First Response is an important component of prehospital care for medical emergencies, particularly cardiac arrest, in many countries. This intervention entails the mobilisation of volunteers, known as Community First Responders (CFRs), by the Emergency Medical Services to respond to medical emergencies in their locality. They include lay responders and/or professional responders (e.g. police officers, fire fighters, and general practitioners). A wide variety of factors are thought to motivate CFRs to join and remain engaged in Voluntary First Response schemes, such as the availability of learning opportunities, recognition, counselling, and leadership. The aim of this review is to develop an in-depth understanding of CFR motivation, including the factors that influence the initial decision to volunteer as a CFR and the factors that sustain involvement in Voluntary First Response over time. Any factors relevant to CFR de-motivation and turnover will also be examined. Methods: This is a protocol for a qualitative systematic review of the factors that influence the motivation of individuals to participate in Voluntary First Response. A systematic search will be carried out on seven electronic databases. Qualitative studies, mixed-methods studies, and any other studies producing data relating to the review question will be eligible for inclusion. Title and abstract screening, as well as full text screening, will be completed independently by two authors. A narrative synthesis, which is an established qualitative synthesis methodology, will be performed. The quality of each of the included studies will be critically appraised. Discussion: The findings of this review will be used to optimise the intervention of Voluntary First Response. Specifically, the results will inform the design and organisation of Voluntary First Response schemes, including their recruitment, training, and psychological support processes. This could benefit a range of stakeholders, including CFRs, paramedics, emergency physicians, patients, and the public.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
| | - Iris Oving
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Viet-Hai Phung
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, Sarah Swift Building, University of Lincoln, Lincoln, LN5 7AT, UK
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, H91 TK33, Ireland
- National Ambulance Service, Health Service Executive, St. Eunan's Hall, St Conal's Hospital, Letterkenny, Donegal, F92 XK84, Ireland
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