1
|
Apiratwarakul K, Ienghong K, Mitsungnern T, Kotruchin P, Phungoen P, Bhudhisawasdi V. Use of a Motorlance to Deliver Emergency Medical Services; a Prospective Cross Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e48. [PMID: 31602431 PMCID: PMC6785216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: Access time to patients with critical or emergent situations outside the hospital is a critical factor that affects both severity of injury and survival. This study aimed to compare the access time to the scene of an emergency situation between a traditional ambulance and motorlance. Methods: This prospective cross sectional study was conducted on all users of emergency call, Srinagarind Hospital, Thailand, from June to December 2018, who received a registration number from the command center. Results: 504 emergency-service operations were examined over a six-month period, 252 (50%) of which were carried out by motorlance. The mean activation time for motorlance and ambulance were 0.57 ± 0.22 minutes and 1.11 ± 0.18 minutes, respectively (p<0.001). Mean response time for motorlance was significantly lower (5.57 ± 1.21 versus 7.29 ± 1.32 minutes; p < 0.001). The response times during 6 a.m. to 6 p.m. were 5.26 ± 1.11 minutes for motorlance and 7.15 ± 1.39 minutes for ambulance (p < 0.001). These measures for night time (6 p.m. to 6 a.m.) were 5.58 ± 1.21 minutes and 8.01 ± 1.30 minutes, respectively (p < 0.001). The mean automated external defibrillator (AED) waiting time for motorlance and ambulance were 5.26 ± 2.36 minutes and 9.24 ± 3.30 minutes, respectively (p = 0.012). The survival rate of patients after AED use in motorlance and ambulance was 80% versus 37.5%; p<0.001. Conclusion: Emergency service delivery by motorlance had lower mean activation time, response time, AED time, and mortality rate of cardiac arrest patients compared to ambulance. It seems that motorlance could be considered as an effective and applicable device in emergency medical service delivery, especially in crowded cities with heavy traffic.
Collapse
Affiliation(s)
- Korakot Apiratwarakul
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Research group for emergency patients care and emergency medical services, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonwon Ienghong
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thapanawong Mitsungnern
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pariwat Phungoen
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | |
Collapse
|
2
|
Pathak A, Agrawal N, Mehra L, Mathur A, Diwan V. First Aid Practices and Health-Seeking Behaviors of Caregivers for Unintentional Childhood Injuries in Ujjain, India: A Community-Based Cross-Sectional Study. CHILDREN-BASEL 2018; 5:children5090124. [PMID: 30200628 PMCID: PMC6162460 DOI: 10.3390/children5090124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/02/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022]
Abstract
Data on types of community first aid use and treatment provided post-injury from many low‒middle-income countries, including India, are lacking. This cross-sectional study was conducted among children aged one month to 18 years of age, in Ujjain, India, to understand types of first aid given and health-seeking post-injury. A total of 1087 injuries in 1049 children were identified in the past year. A total of 729 (67%) injured children received first aid and 758 (70%) sought some form of health care. Children with burns received the most (86%) first aid, and most children (84%) with road traffic accidents (RTA) sought health care. Most children (52%) sought health care from a private health care facility; most children (65%) were transported to a health care facility within the golden hour. Motorbikes were the most preferred (50%) mode of transport. Only 1% of the injured used ambulance services. Commonly reported methods or substances for first aid included the use of coconut oil on wounds from falls (38%) and burns (44%), the use of antiseptic cream on wounds from RTA (31%), the application of turmeric for wounds from falls (16%), and rubbing of metal on a bitten area (47%). For most injuries, appropriate, locally available substances were used. Potentially harmful substances applied included lime, toothpaste, clay, and mud. The findings will help design community interventions to increase the provision of appropriate first aid for childhood injuries.
Collapse
Affiliation(s)
- Ashish Pathak
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain 456006, India.
- Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, SE-751 85 Uppsala, Sweden.
- Global Health-Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- International Centre for Health Research, Ujjain Charitable Trust Hospital and Research Centre, Ujjain 456006, India.
| | - Nitin Agrawal
- Department of Paediatric Surgery, R. D. Gardi Medical College, Ujjain 456006, India.
| | - Love Mehra
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain 456006, India.
| | - Aditya Mathur
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain 456006, India.
| | - Vishal Diwan
- Global Health-Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- International Centre for Health Research, Ujjain Charitable Trust Hospital and Research Centre, Ujjain 456006, India.
- Department of Public Health & Environment, R. D. Gardi Medical College, Ujjain 456006, India.
| |
Collapse
|
3
|
Schwartz J, Dreyer RP, Murugiah K, Ranasinghe I. Contemporary Prehospital Emergency Medical Services Response Times for Suspected Stroke in the United States. PREHOSP EMERG CARE 2016; 20:560-5. [PMID: 26953776 DOI: 10.3109/10903127.2016.1139219] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE There are no contemporary national-level data on Emergency Medical Services (EMS) response times for suspected stroke in the United States (US). Because effective stroke treatment is time-dependent, we characterized response times for suspected stroke, and examined whether they met guideline recommendations. METHODS Using the National EMS Information System dataset, we included 911 calls for patients ≥ 18 years with an EMS provider impression of stroke. We examined variation in the total EMS response time by dispatch notification of stroke, age, sex, race, region, time of day, day of the week, as well as the proportion of EMS responses that met guideline recommended response times. Total EMS response time included call center dispatch time (receipt of call by dispatch to EMS being notified), EMS dispatch time (dispatch informing EMS to EMS starts moving), time to scene (EMS starts moving to EMS arrival on scene), time on scene (EMS arrival on scene to EMS leaving scene), and transport time (EMS leaving scene to reaching treatment facility). RESULTS We identified 184,179 events with primary impressions of stroke (mean age 70.4 ± 16.4 years, 55% male). Median total EMS response time was 36 (IQR 28.7-48.0) minutes. Longer response times were observed for patients aged 65-74 years, of white race, females, and from non-urban areas. Dispatch identification of stroke versus "other" was associated with marginally faster response times (36.0 versus 36.7 minutes, p < 0.01). When compared to recommended guidelines, 78% of EMS responses met dispatch delay of <1 minute, 72% met time to scene of <8 minutes, and 46% met on-scene time of <15 minutes. CONCLUSIONS In the United States, time from receipt of 9-1-1 calls to treatment center arrival takes a median of 36 minutes for stroke patients, an improvement upon previously published times. The fact that 22%-46% of EMS responses did not meet stroke guidelines highlights an opportunity for improvement. Future studies should examine EMS diagnostic accuracy nationally or regionally using outcomes based approaches, as accurate recognition of prehospital strokes is vital in order to improve response times, adhere to guidelines, and ultimately provide timely and effective stroke treatment.
Collapse
|
4
|
Affiliation(s)
- F Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | |
Collapse
|
5
|
Does the Implementation of an Advanced Life Support Quick Response Vehicle (QRV) in an Integrated Fire/EMS System Improve Patient Contact Response Time? Prehosp Disaster Med 2015; 30:382-4. [DOI: 10.1017/s1049023x15004732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundThe current Fire/Emergency Medical Services (EMS) model throughout the United States involves emergency vehicles which respond from a primary location (ie, firehouse or municipal facility) to emergency calls. Quick response vehicles (QRVs) have been used in various Fire/EMS systems; however, their effectiveness has never been studied.ObjectivesThe goal of this study was to determine if patient response times would decrease by placing an Advanced Life Support (ALS) QRV in an integrated Fire/EMS system.MethodsResponse times from an integrated Fire/EMS system with an annual EMS call volume of 3,261 were evaluated over the three years prior to the implementation of this study. For a 2-month period, an ALS QRV staffed by a firefighter/paramedic responded to emergency calls during peak call volume hours of 8:00 am to 5:00 pm. The staging of this vehicle was based on historical call volume percentages using respective geocodes as well as system requirements during multiple emergency dispatches.ResultsPrior to the study, the citywide average response time for the twelve months preceding was 5.44 minutes. During the study, the citywide average response time decreased to 4.09 minutes, resulting in a 27.62% reduction in patient response time.ConclusionThe implementation of an ALS QRV in an integrated Fire/EMS system reduces patient response time. Having a QRV that is not staged continuously in a traditional fire station or municipal location reduces the time needed to reach patients. Also, using predictive models of historic call volume can aid Fire and EMS administrators in reduction of call response times.AndersonDW, DhindsaHS, WanW, SalotD. Does the implementation of an Advanced Life Support quick response vehicle (QRV) in an integrated Fire/EMS system improve patient contact response time?Prehosp Disaster Med. 2015;30(4):1 – 3.
Collapse
|
6
|
Tanaka Y, Yamada H, Tamasaku S, Inaba H. The fast emergency vehicle pre-emption system improved the outcomes of out-of-hospital cardiac arrest. Am J Emerg Med 2013; 31:1466-71. [DOI: 10.1016/j.ajem.2013.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/24/2013] [Accepted: 07/28/2013] [Indexed: 12/01/2022] Open
|
7
|
Abstract
INTRODUCTION Emergency medical services (EMS) systems are a central component of the healthcare system, particularly for older patients. As currently configured, EMS transport is fundamentally petroleum dependent. Petroleum scarcity is an emerging public health concern, particularly for patient transport. Little is known regarding EMS fuel use, potential impacts of scarcity on operations, or strategies to minimize these impacts. OBJECTIVE The objective of this study was to characterize the fuel use of a large, urban, hospital-based, dynamically-deployed EMS system, and to identify broad optimization categories to minimize EMS's petroleum dependence. METHODS Fuel use was reviewed retrospectively using fuel purchasing and maintenance data from January 2007 through September 2008. Data on unit-hours, call volume, and patient transports also were collected. Data were processed using descriptive statistics. RESULTS During the study period, a fleet of 35 diesel ambulances operated for 277,849 unit-hours and traveled 1,902,710 miles. Detailed mileage data were available for 66,527 unit-hours, 23.9% of the sample. Overall, vehicles averaged 6.6.89 (6.71, 7.08) miles per gallon (mpg), 11.5 (10.4, 12.6) miles were travelled per call, and 16.2 (14.8, 17.6) miles per transport; 2.7 (2.4, 2.9) gallons of fuel were used per transport. CONCLUSIONS In this EMS system, operations are fundamentally dependent on petroleum. Mileage estimates can serve as a baseline to evaluate interventions for reducing petroleum dependence and in contingency planning. As cost pressures increase and these interventions become more common, systematic evaluations will be important.
Collapse
|
8
|
Hess J, Bednarz D, Bae J, Pierce J. Petroleum and health care: evaluating and managing health care's vulnerability to petroleum supply shifts. Am J Public Health 2011; 101:1568-79. [PMID: 21778473 DOI: 10.2105/ajph.2011.300233] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Petroleum is used widely in health care-primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies-and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.
Collapse
Affiliation(s)
- Jeremy Hess
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30303, USA.
| | | | | | | |
Collapse
|
9
|
Nakstad AR, Bjelland B, Sandberg M. Medical emergency motorcycle--is it useful in a Scandinavian Emergency Medical Service? Scand J Trauma Resusc Emerg Med 2009; 17:9. [PMID: 19239681 PMCID: PMC2652419 DOI: 10.1186/1757-7241-17-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 02/24/2009] [Indexed: 11/13/2022] Open
Abstract
Background Medical emergency motorcycles (MEM) can be used in time-critical conditions like cardiac arrest and multi-traumatized patients in an attempt to reduce the response time. Other potential benefits with MEM are more efficient patient evaluation, reduction of unnecessary EMS car ambulance missions and reduced cost. The potential benefits have been evaluated in this study. The incidence of accidents when operating the vehicle was also of interest. Methods A prospective study was performed when MEM was introduced as a trial in an urban ambulance service in Norway. Results A total of 703 MEM missions were registered in the period. The mean emergency driving time was significantly shorter for the MEM than for the ambulance car located at the same station (6 min 24 seconds vs. 6 min 54 seconds). In addition to time-critical conditions, the MEM was used to evaluate patients when the need for emergency medical assistance was uncertain, and this practice lead to a reduced number of unnecessary car ambulance missions. No accidents involving the MEM were registered in the study period. The hourly cost of running the MEM was € 29 vs. € 75 for a car ambulance. However, the actual cost benefit is smaller since the weather conditions make it impossible to run a MEM in wintertime. Conclusion The small reduction in driving time when using a MEM instead of a car ambulance was statistically significant but probably of little clinical importance. The number of unnecessary car ambulance missions was reduced. It was cheaper to operate a MEM than a car ambulance, but the cost-effectiveness was reduced since the MEM could not operate 12 months a year. The lack of accidents may be contributed to the extensive training of the drivers and the fact that the vehicle was operated in daylight only.
Collapse
|
10
|
Abstract
OBJECTIVE Ambulances in emergency medical services (EMS) might be supplemented or supported by vehicles that lack the capacity to transport a patient, especially in crowded urban areas. This paper addresses the safety of a first-response vehicle, the medical emergency motorcycle (MEM), which is driven by an emergency medical technician provider. We analysed the number of crashes, as well as the incidence and nature of injuries sustained. MATERIAL AND METHODS A prospective study was conducted from July 2004 to January 2007. Administrative data were collected over this period regarding MEMs operating in a metropolitan EMS group who had responded to 3626 calls. The MEM responders use limited equipment to perform initial assessments and interventions (basic life support and defibrillation). Undergoing an emergency driving course and wearing protective equipment are mandatory. We analysed the number of crashes, the proper use of the protective equipment, and the type and severity of the injuries sustained. RESULTS Accidents included 12 (n=12) motorcycle falls, resulting in three injured MEM drivers. No fatality was registered. One serious injury and two slight accidents occurred. One victim presented a dental trauma and another presented minor abrasion skin lesions. The third sustained a femur fracture. The first and second victims had not been using the protective equipment properly. CONCLUSION MEMs can impart a quick and efficient response to EMS services in urban areas, if managed with acceptable levels of safety. Defensive driving courses as well as correct use of personal protective equipment can improve security.
Collapse
|
11
|
Soares-Oliveira M, Egipto P, Costa I, Cunha-Ribeiro LM. Emergency motorcycle: has it a place in a medical emergency system? Am J Emerg Med 2007; 25:620-2. [PMID: 17606085 DOI: 10.1016/j.ajem.2006.11.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 11/03/2006] [Accepted: 11/12/2006] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION/AIM In an emergency medical service system, response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas, mainly during rush hour. Because prehospital emergency care is required to be efficient and swift, alternative measures to achieve this goal should be addressed. We report our experience with a medical emergency motorcycle (MEM) and propose major criteria for dispatching it. MATERIAL AND METHODS This work presents a prospective analysis of the data relating to MEM calls from July 2004 to December 2005. The analyzed parameters were age, sex, reason for call, action, and need for subsequent transport. A comparison was made of the need to activate more means and, if so, whether the MEM was the first to arrive. RESULTS There were 1972 calls. The average time of arrival at destination was 4.4 +/- 2.5 minutes. The main action consisted of administration of oxygen (n = 626), immobilization (n = 118), and control of hemorrhage (n = 101). In 63% of cases, MEM arrived before other emergency vehicles. In 355 cases (18%), there was no need for transport. CONCLUSION The MEM can intervene in a wide variety of clinical situations and a quick response is guaranteed. Moreover, in specific situations, MEM safely and efficiently permits better management of emergency vehicles. We propose that it should be dispatched mainly in the following situations: true life-threatening cases and uncertain need for an ambulance.
Collapse
Affiliation(s)
- Miguel Soares-Oliveira
- Instituto Nacional de Emergencia Médica R Dr Alfredo Magalhaes, 62, 4000-063 Porto, Portugal.
| | | | | | | |
Collapse
|
12
|
2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 2: Adult basic life support. Resuscitation 2005; 67:187-201. [PMID: 16324988 PMCID: PMC7144408 DOI: 10.1016/j.resuscitation.2005.09.016] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
13
|
MacFarlane C, Benn CA. Evaluation of emergency medical services systems: a classification to assist in determination of indicators. Emerg Med J 2003; 20:188-91. [PMID: 12642542 PMCID: PMC1726053 DOI: 10.1136/emj.20.2.188] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Emergency medical services (EMS) systems, and prehospital care are difficult to evaluate. Accordingly, the true efficacy and value of such systems are difficult to determine. The multitude of variations and combinations of involved factors makes standardisation and comparison difficult, and universal indicators are hard to develop. Various attempts have been made to determine valid indicators of effectiveness, but there has been little success. Prehospital care has been seen by some as a single entity. As a result, experience from well resourced first world trauma centres has been taken, by many, to be applicable to all prehospital situations. This article attempts to assist in the development of valid EMS indicators of performance and effectiveness by categorising prehospital scenarios into a classification reflecting the reality of their conditions of practice.
Collapse
Affiliation(s)
- C MacFarlane
- Emergency Medical Services Training, Gauteng Provincial Government, South Africa.
| | | |
Collapse
|